Vojnosanitetski pregled 2013 Volume 70, Issue 9, Pages: 874-877
https://doi.org/10.2298/VSP1309874K
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Surgical treatment of penetrating atherosclerotic ulcer of the descending aorta
Kovačević Pavle (Faculty of Medicine, Novi Sad + Institute of Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, Sremska Kamenica)
Velicki Lazar (Faculty of Medicine, Novi Sad + Institute of Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, Sremska Kamenica)
Popović Dušan (Institute of Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, Sremska Kamenica)
Ivanović Vladimir (Faculty of Medicine, Novi Sad + Clinic of Cardiovascular Surgery, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica)
Mojašević Renata (Institute of Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, Sremska Kamenica)
Introduction. The term “penetrating atherosclerotic ulcer” (PAU) of the aorta
describes the condition in which ulceration of an aortic atherosclerotic
lesion penetrates the internal elastic lamina into media. PAU is a high-risk
lesion due to its deleterious effects on the integrity of aortic wall, with
potentially fatal outcome. Case report. A patient with intensive, sharp chest
pain irradiating to the back but with no signs of myocardial ischemia on an
electrocardiogram was referred to our hospital. Transthoracic
echocardiography showed no pathological changes of the ascending aorta.
However, multislice computed tomography (CT) showed an aortic ulcer with
varying degree of the subadventitial hemorrhage in the region of the thoracic
aorta at the level of Th 8-9. Due to imminent rupture of the penetrating
aortic ulcer, the patient was promptly prepared for surgery. A 15 cm long
subadventitial hematoma was found intraoperatively in the right
posterolateral aspect of the descending aorta, 5 cm above the diaphragm and 7
cm below the origin of the left subclavial artery. The affected segment of
the aorta was resected, followed by an inlay aortic reconstruction with a
Dacron tube graft of 24 mm. Control CT revealed satisfactory reconstruction
of the descending aorta. Conclusion. PAU is a rare, but potentially fatal
disease. Open surgery in patients with PAU is an effective treatment
strategy, although endovascular treatment options are emerging.
Keywords: aorta, thoracic, aortic rupture, atherosclerosis, ulcer, diagnostic techniques and procedures, cardiovascular surgical procedures, transplants