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Author Spotlight: Using Point-of-Care Ultrasound for Comprehensive Evaluation of the Abdominal Aorta
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The Rarity of Penetrating Ulcer with Intramural Hematoma of the Ascending Aorta

Joshua Patino1, Patrick T Roughneen2

  • 1School of Medicine, Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Texas, United States of America.

Brazilian Journal of Cardiovascular Surgery
|June 8, 2022
PubMed

Insights

A rare case of penetrating atherosclerotic ulcer with intramural hematoma in the ascending aorta was successfully treated. This complex aortic condition, seen in less than 1% of acute aortic syndromes, required surgical intervention.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Medicine
  • Aortic Pathology

Background:

  • Penetrating atherosclerotic ulcers (PAUs) and intramural hematomas (IMHs) are distinct but can coexist within the aorta.
  • Acute aortic syndromes encompass a spectrum of life-threatening conditions affecting the aorta.
  • The simultaneous occurrence of PAU and IMH in the ascending aorta is exceptionally rare.

Observation:

  • A 58-year-old male presented with symptomatic multiple penetrating atherosclerotic ulcers and an intramural hematoma in the ascending aorta.
  • The patient's condition posed a significant surgical challenge due to the complex aortic pathology.
  • Diagnostic imaging confirmed the extent and nature of the aortic disease.

Findings:

  • Successful surgical repair was achieved using a 24-mm Gelweave graft in the ascending aorta.
  • The patient experienced a rapid recovery, being discharged within four days of the operation.
  • Postoperative follow-up at 14 months revealed the patient remained asymptomatic.

Implications:

  • This case highlights a rare presentation of acute aortic syndrome, emphasizing the importance of accurate diagnosis and tailored surgical strategies.
  • The successful management underscores the efficacy of surgical grafting for complex PAU and IMH in the ascending aorta.
  • Further research into the pathogenesis and optimal treatment of combined PAU-IMH is warranted to improve patient outcomes.

Keywords:
AortaAtherosclerosisHematomaPatient DischargeUlcer

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