Aortic Remodeling in Patients Undergoing Endovascular Repair for Penetrating Aortic Ulcer With High-Risk Features

The natural history of penetrating aortic ulcers (PAUs) with high-risk radiologic features after thoracic endovascular aortic repair (TEVAR) remains incompletely characterized. This study assessed aortic remodeling and midterm outcomes after TEVAR for such lesions.

We retrospectively reviewed patients undergoing TEVAR for high-risk PAUs between 2016 and 2022. Of 220 TEVAR cases, 12 patients (5.5%) met inclusion criteria with appropriate follow-up. Aortic remodeling was assessed per current societal guidelines.

The cohort included 8 men (66%) with a median age of 73 years and a median follow-up of 31 months (interquartile range, 12.75-59 months). Most PAUs (58%) were located in zone 3; 33% had multiple ulcers, often with >1 high-risk feature. Pre- and post-TEVAR main PAU + intramural hematoma depth averaged 10.1 ± 4.5 mm and 10.1 ± 8.1 mm, respectively. Aortic diameter increased from 41.3 ± 6.0 mm to 45.3 ± 10.4 mm. Complete thrombosis of the main PAU was observed in 92% of patients. Aortic remodeling was positive in 25% and stable in 58% of cases. No 30-day mortality occurred; however, 3 patients (25%) died of nonaortic causes during follow-up. Two reinterventions (17%) were performed for type 2 endoleak and new PAU formation due to cocaine use.

TEVAR for PAUs with high-risk features results in complete thrombosis in most cases. Whereas positive aortic remodeling occurred in a subset, most patients experienced stabilization of aortic dimensions during midterm follow-up.