Outcomes of endovascular stent graft repair for penetrating aortic ulcers with or without intramural hematoma.

OBJECTIVE To investigate the outcomes of endovascular repair for penetrating aortic ulcers (PAUs) with or without intramural hematoma (IMH). METHODS Patients with PAUs who underwent thoracic endovascular aortic repair (TEVAR) or endovascular abdominal aortic repair (EVAR) in our center were enrolled. Patient demographics, presenting symptoms, and anatomic characteristics were collected and analyzed to investigate the TEVAR/EVAR indications, perioperative complications, and mortality. RESULTS A total of 138 PAU patients were identified. Fifty-eight (42.0%) patients were associated with IMH. Compared to patients without IMH, patients with IMH showed significantly higher emergency admission rates (P <0.01), a larger aortic diameter (P =0.03), and stent-induced new entry (SINE) development incidence (P =0.02). There were no significant differences in mortality and free from reintervention between patients with PAUs with and without IMH during their follow-ups. However, cumulative survival rates calculated by Kaplan-Meier analysis of patients undergoing TEVAR/EVAR during their first hospitalization were significantly higher than those having delayed TEVAR/EVAR during their follow-up. CONCLUSIONS TEVAR/EVAR was safe and effective with encouraging outcomes for patients with PAUs with or without IMH and can be used more aggressively in symptomatic patients. PAUs with IMH did not seem to adversely affect long-term mortality, but SINE was more likely to develop.