Endovascular Repair of Infrarenal Abdominal Aorta Penetrating Atherosclerotic Ulcers: Review of Our Experience

Penetrating atherosclerotic ulcer (PAU) of infrarenal aorta is a rare but life-threatening entity affecting elderly patients with severe atherosclerotic disease, and potentially complicated with intramural hematoma, adventitial pseudoaneurysm or aortic rupture. Although open surgical repair is an effective therapeutic option, endovascular treatment is emerging as an attractive alternative, especially in high-risk elderly patients.We report our experience with four cases of endovascular stent-grafting of infrarenal aorta PAU. All patients presented with abdominal or lumbar pain, and two of them with shock. The diagnosis was based on CT scan and angiography that demonstrated infrarenal pseudoaneurysm in two and focal nonaneurysmal infrarenal aortic rupture in the other two patients, secondary to PAU. Endoluminal transfemoral stent-grafting was successfully delivered in all patients. One of them died 5 days after the intervention because of multiple organ failure. During a mean follow-up period of 24 months, no endoleak, aneurysm evolution or stent-graft failure were found in the remaining three patients.