Mid and Long-term Results of Endovascular Treatment of Thoracic Penetrating Aortic Ulcers.

INTRODUCTION AND

OBJECTIVES

Thoracic penetrating aortic ulcers are an infrequent, but potentially serious entity, and its treatment is still controversial. This study presents the long-term results of the endovascular treatment for penetrating ulcers of the thoracic aorta.

METHODS

Between 1998 and 2023, 42 patients diagnosed with thoracic penetrating aortic ulcers were treated with endografts at a tertiary care hospital. Preoperative, intraoperative, and follow-up complications and mortality data were collected and analyzed. Survival rates during follow-up were estimated using Kaplan-Meier curves.

RESULTS

Treatment was indicated for symptomatic cases in 14 patients (33.3%), most of whom presented with thoracic or dorsal pain, 1 with distal embolization, and 2 with aortic rupture. Standard thoracic endografts were used in 38 cases (90%), while branched/scalloped and/or fenestrated endografts were employed in 4 cases, with an average of 1.2 endografts per patient. Eight cases (19%) required prior revascularization of supra-aortic trunks. Technical success was 100%, with no intraoperative deaths or open conversions. In-hospital medical complications occurred in 16.6% of patients, and the 30-day cumulative mortality rate was 4.7%. After a mean follow-up of 71.7 months (range: 0.1-283 months), the endoleak rate was 19% and the cumulative 5-year reintervention-free survival rate was 80.6%. The overall survival rates at 1, 5, and 10 years were 87.4%, 77.5%, and 60.5%, respectively.

CONCLUSIONS

Endovascular treatment for penetrating ulcers of the thoracic aorta demonstrates favorable short and long-term outcomes, with high technical success and low aorta/procedure related mortality.Clinical ImpactThis study reinforces TEVAR as a safe and effective first-line therapy for penetrating aortic ulcers, offering clinicians strong long-term data to support decision-making in a high-risk, elderly population. The findings underscore that most PAUs can be treated with limited aortic coverage and minimal adjunctive procedures, reducing procedural complexity and morbidity. The extended follow-up-among the longest reported-highlights durable aortic exclusion, while emphasizing the importance of lifelong imaging due to endoleak-related reinterventions.