Penetrating Aortic Ulcers and Pseudoaneurysms Managed with Endovascular Aortic Arch Repair

This study investigated the outcomes of fenestrated/branched aortic arch repair (f/bTEVAR) in patients with chronic penetrating aortic ulcers (PAU) or pseudoaneurysms.

A single-center retrospective analysis of patients managed with f/bTEVAR for PAU or pseudoaneurysms involving the aortic arch between September 1st, 2011, and December 31st, 2023, was conducted. Any outpouching-like lesion leading to an aortic diameter ≥50% of the normal one was considered pseudoaneurysm, while similar lesions leading to a diameter increase <50% were considered PAUs. Primary outcomes were technical success, mortality and stroke at 30 days.

Twenty-three patients had PAU and 28 pseudoaneurysm [age: 72 (Q1:67, Q3:76) years, 78.4% males]. Peripheral arterial disease was more common among PAU patients (PAU: 43.5% vs. pseudoaneurysm: 10.7%, P = 0.007). Only patients with pseudoaneurysm underwent urgent repair (PAU: 0% vs. pseudoaneurysms: 25%, P = 0.03). No differences in device configuration were detected. Technical success was 100% in PAUs and 92.8% in pseudoaneurysms (P = 0.67). Thirty-day mortality was 4.3% in PAUs versus 10.7% in pseudoaneurysms (P = 0.40). Four (7.8%) major strokes were recorded; 4.3% in PAUs versus 10.7% in pseudoaneurysms (P = 0.40). The median follow-up was 12 months (Q1: 1, Q3: 24). The survival was 80.6% (SE 8.8%) in PAUs versus 79.6% (SE 8.2%) in pseudoaneurysms (log-rank, P = 0.45).

In this small cohort of f/bTEVAR for PAUs versus pseudoaneurysms, technical success and mortality were similar. The major stroke rate exceeded 10.0% in pseudoaneurysm patients, alarming on the safety of the procedure in this subgroup. Larger studies are needed to verify the need for differentiation of these pathologies.