Skip to main content
SpringerLink
Log in

Penetrating Aortic Ulcer and Intramural Hematoma

  • Review
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Acute aortic syndromes include a variety of overlapping clinical and anatomic diseases. Penetrating aortic ulcer (PAU), intramural hematoma (IMH) and aortic dissection can occur as isolated processes or can be found in association. All these entities are potentially life threatening, so prompt diagnosis and treatment is of paramount importance. PAU and IMH lesions in the Stanford Type A distribution often require urgent open surgical repair. Lesions in the Stanford Type B distribution may be managed medically in the absence of symptoms or progression; however, a low threshold for endovascular or surgical treatment should be maintained. This review summarizes the clinical presentation, epidemiology, diagnosis, indications for treatment and endovascular strategies in patients with PAU or IMH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Akin I, Kische S, Ince H, Nienaber C. Penetrating aortic ulcer, intramural hematoma, acute aortic syndrome: when to do what. J Cardiovasc Surg (Torino). 2012;53(1 Suppl 1):83–90.

    CAS  Google Scholar 

  2. Vilacosta I, San Roman JA. Acute aortic syndrome. Heart (Br Card Soc). 2001;85(4):365–8.

    Article  CAS  Google Scholar 

  3. Coady MA, Rizzo JA, Hammond GL, Pierce JG, Kopf GS, Elefteriades JA. Penetrating ulcer of the thoracic aorta: what is it? How do we recognize it? How do we manage it? J Vasc Surg. 1998;27(6):1006–15 (discussion 15-6).

    Article  CAS  PubMed  Google Scholar 

  4. Harris JA, Bis KG, Glover JL, Bendick PJ, Shetty A, Brown OW. Penetrating atherosclerotic ulcers of the aorta. J Vasc Surg. 1994;19(1):90–8 (discussion 8-9).

    Article  CAS  PubMed  Google Scholar 

  5. Stanson AW, Kazmier FJ, Hollier LH, Edwards WD, Pairolero PC, Sheedy PF, et al. Penetrating atherosclerotic ulcers of the thoracic aorta: natural history and clinicopathologic correlations. Ann Vasc Surg. 1986;1(1):15–23.

    Article  CAS  PubMed  Google Scholar 

  6. Sundt TM. Intramural hematoma and penetrating atherosclerotic ulcer of the aorta. Ann Thorac Surg. 2007;83(2):S835–41 (discussion S46-50).

    Article  PubMed  Google Scholar 

  7. Shennan T. Dissecting aneurysms. Medical Research Special Council Report Series. 1934;N8(193).

  8. Patel PJ, Grande W, Hieb RA. Endovascular management of acute aortic syndromes. Semin Intervent Radiol. 2011;28(1):10–23.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Svensson LG, Labib SB, Eisenhauer AC, Butterly JR. Intimal tear without hematoma: an important variant of aortic dissection that can elude current imaging techniques. Circulation. 1999;99(10):1331–6.

    Article  CAS  PubMed  Google Scholar 

  10. Cho KR, Stanson AW, Potter DD, Cherry KJ, Schaff HV, Sundt TM 3rd. Penetrating atherosclerotic ulcer of the descending thoracic aorta and arch. J Thorac Cardiovasc Surg. 2004;127(5):1393–9 (discussion 9-401).

    Article  PubMed  Google Scholar 

  11. Maddu KK, Shuaib W, Telleria J, Johnson JO, Khosa F. Nontraumatic acute aortic emergencies: Part 1, Acute aortic syndrome. AJR Am J Roentgenol. 2014;202(3):656–65.

    Article  PubMed  Google Scholar 

  12. Nathan DP, Boonn W, Lai E, Wang GJ, Desai N, Woo EY, et al. Presentation, complications, and natural history of penetrating atherosclerotic ulcer disease. J Vasc Surg. 2012;55(1):10–5.

    Article  PubMed  Google Scholar 

  13. Quint LE, Williams DM, Francis IR, Monaghan HM, Sonnad SS, Patel S, et al. Ulcerlike lesions of the aorta: imaging features and natural history. Radiology. 2001;218(3):719–23.

    Article  CAS  PubMed  Google Scholar 

  14. Troxler M, Mavor AI, Homer-Vanniasinkam S. Penetrating atherosclerotic ulcers of the aorta. Br J Surg. 2001;88(9):1169–77.

    Article  CAS  PubMed  Google Scholar 

  15. Singhal P, Lin Z. Penetrating atheromatous ulcer of ascending aorta: a case report and review of literature. Heart Lung Circ. 2008;17(5):380–2.

    Article  CAS  PubMed  Google Scholar 

  16. Tittle SL, Lynch RJ, Cole PE, Singh HS, Rizzo JA, Kopf GS, et al. Midterm follow-up of penetrating ulcer and intramural hematoma of the aorta. J Thorac Cardiovasc Surg. 2002;123(6):1051–9.

    Article  PubMed  Google Scholar 

  17. Georgiadis GS, Antoniou GA, Georgakarakos EI, Nikolopoulos ES, Papanas N, Trellopoulos G, et al. Surgical or endovascular therapy of abdominal penetrating aortic ulcers and their natural history: a systematic review. J Vasc Interv Radiol. 2013;24(10):1437–49.

    Article  PubMed  Google Scholar 

  18. Toda R, Moriyama Y, Iguro Y, Matsumoto H, Masuda H, Ueno T. Penetrating atherosclerotic ulcer. Surg Today. 2001;31(1):32–5.

    Article  CAS  PubMed  Google Scholar 

  19. Wooley CF, Sparks EH, Boudoulas H. Aortic pain. Prog Cardiovasc Dis. 1998;40(6):563–89.

    Article  CAS  PubMed  Google Scholar 

  20. Farooq MM, Kling K, Yamini D, Gelabert HA, Baker JD, Freischlag JA. Penetrating ulceration of the infrarenal aorta: case reports of an embolic and an asymptomatic lesion. Ann Vasc Surg. 2001;15(2):255–9.

    Article  CAS  PubMed  Google Scholar 

  21. Goldstein DJ, Flores RM, Todd GJ. Rupture of a nonaneurysmal atherosclerotic infrarenal aorta. J Vasc Surg. 1997;26(4):700–3.

    Article  CAS  PubMed  Google Scholar 

  22. Ganaha F, Miller DC, Sugimoto K, Do YS, Minamiguchi H, Saito H, et al. Prognosis of aortic intramural hematoma with and without penetrating atherosclerotic ulcer: a clinical and radiological analysis. Circulation. 2002;106(3):342–8.

    Article  PubMed  Google Scholar 

  23. Krukenberg E. Contribution to the question of dissecting aneurysm. Beitr Pathol Anat Allg Pathol. 1920;67:329–51.

    Google Scholar 

  24. Park KH, Lim C, Choi JH, Sung K, Kim K, Lee YT, et al. Prevalence of aortic intimal defect in surgically treated acute Type A intramural hematoma. Ann Thorac Surg. 2008;86(5):1494–500.

    Article  PubMed  Google Scholar 

  25. Chao CP, Walker TG, Kalva SP. Natural history and CT appearances of aortic intramural hematoma. Radiographics. 2009;29(3):791–804.

    Article  PubMed  Google Scholar 

  26. Evangelista A, Mukherjee D, Mehta RH, O’Gara PT, Fattori R, Cooper JV, et al. Acute intramural hematoma of the aorta: a mystery in evolution. Circulation. 2005;111(8):1063–70.

    Article  PubMed  Google Scholar 

  27. Sundt TM. Intramural hematoma and penetrating aortic ulcer. Curr Opin Cardiol. 2007;22(6):504–9.

    Article  PubMed  Google Scholar 

  28. Song JK, Kim HS, Kang DH, Lim TH, Song MG, Park SW, et al. Different clinical features of aortic intramural hematoma versus dissection involving the ascending aorta. J Am Coll Cardiol. 2001;37(6):1604–10.

    Article  CAS  PubMed  Google Scholar 

  29. Tolenaar JL, Harris KM, Upchurch GR Jr, Evangelista A, Moll FL, di Eusanio M, et al. The differences and similarities between intramural hematoma of the descending aorta and acute Type B dissection. J Vasc Surg. 2013;58(6):1498–504.

    Article  PubMed  Google Scholar 

  30. Nienaber CA. Commentary: staging of aortic intramural hematoma: an enemy behind a smooth surface? J Endovasc Ther. 2010;17(5):622–3.

    Article  PubMed  Google Scholar 

  31. Song JK, Yim JH, Ahn JM, Kim DH, Kang JW, Lee TY, et al. Outcomes of patients with acute Type A aortic intramural hematoma. Circulation. 2009;120(21):2046–52.

    Article  PubMed  Google Scholar 

  32. Riambau V, Böckler D, Brunkwall J, Cao P, Chiesa R, Coppi G, et al. Editor’s choice—management of descending thoracic aorta diseases: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2017;53(1):4–52.

    Article  CAS  PubMed  Google Scholar 

  33. von Kodolitsch Y, Csosz SK, Koschyk DH, Schalwat I, Loose R, Karck M, et al. Intramural hematoma of the aorta: predictors of progression to dissection and rupture. Circulation. 2003;107(8):1158–63.

    Article  Google Scholar 

  34. Harris KM, Braverman AC, Eagle KA, Woznicki EM, Pyeritz RE, Myrmel T, et al. Acute aortic intramural hematoma: an analysis from the International Registry of Acute Aortic Dissection. Circulation. 2012;126(11 Suppl 1):S91–6.

    Article  PubMed  Google Scholar 

  35. Evangelista A, Dominguez R, Sebastia C, Salas A, Permanyer-Miralda G, Avegliano G, et al. Prognostic value of clinical and morphologic findings in short-term evolution of aortic intramural haematoma. Therapeutic implications. Eur Heart J. 2004;25(1):81–7.

    Article  PubMed  Google Scholar 

  36. Erbel R, Alfonso F, Boileau C, Dirsch O, Eber B, Haverich A, et al. Diagnosis and management of aortic dissection. Eur Heart J. 2001;22(18):1642–81.

    Article  CAS  PubMed  Google Scholar 

  37. Choi SH, Choi SJ, Kim JH, Bae SJ, Lee JS, Song KS, et al. Useful CT findings for predicting the progression of aortic intramural hematoma to overt aortic dissection. J Comput Assist Tomogr. 2001;25(2):295–9.

    Article  CAS  PubMed  Google Scholar 

  38. Tsai TT, Nienaber CA, Eagle KA. Acute aortic syndromes. Circulation. 2005;112(24):3802–13.

    Article  PubMed  Google Scholar 

  39. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000;283(7):897–903.

    Article  CAS  PubMed  Google Scholar 

  40. Eggebrecht H, Naber CK, Bruch C, Kroger K, von Birgelen C, Schmermund A, et al. Value of plasma fibrin D-dimers for detection of acute aortic dissection. J Am Coll Cardiol. 2004;44(4):804–9.

    Article  CAS  PubMed  Google Scholar 

  41. Shinohara T, Suzuki K, Okada M, Shiigai M, Shimizu M, Maehara T, et al. Soluble elastin fragments in serum are elevated in acute aortic dissection. Arterioscler Thromb Vasc Biol. 2003;23(10):1839–44.

    Article  CAS  PubMed  Google Scholar 

  42. Suzuki T, Distante A, Zizza A, Trimarchi S, Villani M, Salerno Uriarte JA, et al. Diagnosis of acute aortic dissection by D-dimer: the International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) experience. Circulation. 2009;119(20):2702–7.

    Article  PubMed  Google Scholar 

  43. Janosi RA, Gorla R, Tsagakis K, Kahlert P, Horacek M, Bruckschen F, et al. Thoracic endovascular repair of complicated penetrating aortic ulcer: an 11-year single-center experience. J Endovasc Ther. 2016;23(1):150–9.

    Article  PubMed  Google Scholar 

  44. Ciccone MM, Dentamaro I, Masi F, Carbonara S, Ricci G. Advances in the diagnosis of acute aortic syndromes: role of imaging techniques. Vasc Med. 2016;21(3):239–50.

    Article  CAS  PubMed  Google Scholar 

  45. Salvolini L, Renda P, Fiore D, Scaglione M, Piccoli G, Giovagnoni A. Acute aortic syndromes: role of multi-detector row CT. Eur J Radiol. 2008;65(3):350–8.

    Article  PubMed  Google Scholar 

  46. Bischoff MS, Geisbusch P, Peters AS, Hyhlik-Durr A, Bockler D. Penetrating aortic ulcer: defining risks and therapeutic strategies. Herz. 2011;36(6):498–504.

    Article  CAS  PubMed  Google Scholar 

  47. Evangelista A, Carro A, Moral S, Teixido-Tura G, Rodriguez-Palomares JF, Cuellar H, et al. Imaging modalities for the early diagnosis of acute aortic syndrome. Nat Rev Cardiol. 2013;10(8):477–86.

    Article  PubMed  Google Scholar 

  48. Nienaber CA. The role of imaging in acute aortic syndromes. Eur Heart J Cardiovasc Imaging. 2013;14(1):15–23.

    Article  PubMed  Google Scholar 

  49. Qahtani SA, Kandeel AY, Breault S, Jouannic AM, Qanadli SD. Prevalence of acute coronary syndrome in patients suspected for pulmonary embolism or acute aortic syndrome: rationale for the triple rule-out concept. J Clin Med Res. 2015;7(8):627–31.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Evangelista A, Garcia-del-Castillo H, Gonzalez-Alujas T, Dominguez-Oronoz R, Salas A, Permanyer-Miralda G, et al. Diagnosis of ascending aortic dissection by transesophageal echocardiography: utility of M-mode in recognizing artifacts. J Am Coll Cardiol. 1996;27(1):102–7.

    Article  CAS  PubMed  Google Scholar 

  51. Roselli EE, Idrees J, Greenberg RK, Johnston DR, Lytle BW. Endovascular stent grafting for ascending aorta repair in high-risk patients. J Thorac Cardiovasc Surg. 2015;149(1):144–51.

    Article  PubMed  Google Scholar 

  52. Carpenter SW, Kodolitsch YV, Debus ES, Wipper S, Tsilimparis N, Larena-Avellaneda A, et al. Acute aortic syndromes: definition, prognosis and treatment options. J Cardiovasc Surg. 2014;55(2 Suppl 1):133–44.

    CAS  Google Scholar 

  53. Hata M, Hata H, Sezai A, Yoshitake I, Wakui S, Shiono M. Optimal treatment strategy for Type A acute aortic dissection with intramural hematoma. J Thorac Cardiovasc Surg. 2014;147(1):307–11.

    Article  PubMed  Google Scholar 

  54. Kaji S, Akasaka T, Horibata Y, Nishigami K, Shono H, Katayama M, et al. Long-term prognosis of patients with Type A aortic intramural hematoma. Circulation. 2002;106(12 Suppl 1):I248–52.

    PubMed  Google Scholar 

  55. Watanabe S, Hanyu M, Arai Y, Nagasawa A. Initial medical treatment for acute Type A intramural hematoma and aortic dissection. Ann Thorac Surg. 2013;96(6):2142–6.

    Article  PubMed  Google Scholar 

  56. Bosiers MJ, Donas KP, Mangialardi N, Torsello G, Riambau V, Criado FJ, et al. European multicenter registry for the performance of the Chimney/Snorkel technique in the treatment of aortic arch pathologic conditions. Ann Thorac Surg. 2016;101(6):2224–30.

    Article  PubMed  Google Scholar 

  57. Kurimoto Y, Maruyama R, Ujihira K, Nishioka N, Hasegawa K, Iba Y, et al. Thoracic endovascular aortic repair for challenging aortic arch diseases using fenestrated stent grafts from zone 0. Ann Thorac Surg. 2015;100(1):24–32 (discussion-3).

    Article  PubMed  Google Scholar 

  58. Li Z, Lu Q, Feng R, Zhou J, Zhao Z, Bao J, et al. Outcomes of endovascular repair of ascending aortic dissection in patients unsuitable for direct surgical repair. J Am Coll Cardiol. 2016;68(18):1944–54.

    Article  PubMed  Google Scholar 

  59. Spear R, Haulon S, Ohki T, Tsilimparis N, Kanaoka Y, Milne CP, et al. Subsequent results for arch aneurysm repair with inner branched endografts. Eur J Vasc Endovasc Surg. 2016;51(3):380–5.

    Article  CAS  PubMed  Google Scholar 

  60. Eggebrecht H, Plicht B, Kahlert P, Erbel R. Intramural hematoma and penetrating ulcers: indications to endovascular treatment. Eur J Vasc Endovasc Surg. 2009;38(6):659–65.

    Article  CAS  PubMed  Google Scholar 

  61. Geisbusch P, Kotelis D, Weber TF, Hyhlik-Durr A, Kauczor HU, Bockler D. Early and midterm results after endovascular stent graft repair of penetrating aortic ulcers. J Vasc Surg. 2008;48(6):1361–8.

    Article  PubMed  Google Scholar 

  62. Botta L, Buttazzi K, Russo V, Parlapiano M, Gostoli V, Di Bartolomeo R, et al. Endovascular repair for penetrating atherosclerotic ulcers of the descending thoracic aorta: early and mid-term results. Ann Thorac Surg. 2008;85(3):987–92.

    Article  PubMed  Google Scholar 

  63. Grimm M, Loewe C, Gottardi R, Funovics M, Zimpfer D, Rodler S, et al. Novel insights into the mechanisms and treatment of intramural hematoma affecting the entire thoracic aorta. Ann Thorac Surg. 2008;86(2):453–6.

    Article  PubMed  Google Scholar 

  64. Evangelista A, Dominguez R, Sebastia C, Salas A, Permanyer-Miralda G, Avegliano G, et al. Long-term follow-up of aortic intramural hematoma: predictors of outcome. Circulation. 2003;108(5):583–9.

    Article  PubMed  Google Scholar 

  65. Schoder M, Grabenwoger M, Holzenbein T, Domanovits H, Fleischmann D, Wolf F, et al. Endovascular stent-graft repair of complicated penetrating atherosclerotic ulcers of the descending thoracic aorta. J Vasc Surg. 2002;36(4):720–6.

    Article  PubMed  Google Scholar 

  66. Kos X, Bouchard L, Otal P, Chabbert V, Chemla P, Soula P, et al. Stent-graft treatment of penetrating thoracic aortic ulcers. J Endovasc Ther. 2002;9(Suppl 2):II25–31.

    Article  PubMed  Google Scholar 

  67. Tsuji Y, Tanaka Y, Kitagawa A, Hino Y, Taniguchi T, Sugimoto K, et al. Endovascular stent-graft repair for penetrating atherosclerotic ulcer in the infrarenal abdominal aorta. J Vasc Surg. 2003;38(2):383–8.

    Article  PubMed  Google Scholar 

  68. Eggebrecht H, Baumgart D, Schmermund A, von Birgelen C, Herold U, Wiesemes R, et al. Endovascular stent-graft repair for penetrating atherosclerotic ulcer of the descending aorta. Am J Cardiol. 2003;91(9):1150–3.

    Article  PubMed  Google Scholar 

  69. Demers P, Miller DC, Mitchell RS, Kee ST, Chagonjian L, Dake MD. Stent-graft repair of penetrating atherosclerotic ulcers in the descending thoracic aorta: mid-term results. Ann Thorac Surg. 2004;77(1):81–6.

    Article  PubMed  Google Scholar 

  70. Brinster DR, Wheatley GH 3rd, Williams J, Ramaiah VG, Diethrich EB, Rodriguez-Lopez JA. Are penetrating aortic ulcers best treated using an endovascular approach? Ann Thorac Surg. 2006;82(5):1688–91.

    Article  PubMed  Google Scholar 

  71. Eggebrecht H, Herold U, Schmermund A, Lind AY, Kuhnt O, Martini S, et al. Endovascular stent-graft treatment of penetrating aortic ulcer: results over a median follow-up of 27 months. Am Heart J. 2006;151(2):530–6.

    Article  PubMed  Google Scholar 

  72. Piffaretti G, Tozzi M, Lomazzi C, Rivolta N, Caronno R, Castelli P. Endovascular repair of abdominal infrarenal penetrating aortic ulcers: a prospective observational study. Int J Surg. 2007;5(3):172–5.

    Article  PubMed  Google Scholar 

  73. Dalainas I, Nano G, Medda M, Bianchi P, Casana R, Ramponi F, et al. Endovascular treatment of penetrating aortic ulcers: mid-term results. Eur J Vasc Endovasc Surg. 2007;34(1):74–8.

    Article  CAS  PubMed  Google Scholar 

  74. D’Souza S, Duncan A, Aguila F, Oderich G, Ricotta J, Kalra M, et al. TEVAR for non-aneurysmal thoracic aortic pathology. Catheter Cardiovasc Interv. 2009;74(5):783–6.

    Article  PubMed  Google Scholar 

  75. Clough RE, Mani K, Lyons OT, Bell RE, Zayed HA, Waltham M, et al. Endovascular treatment of acute aortic syndrome. J Vasc Surg. 2011;54(6):1580–7.

    Article  PubMed  Google Scholar 

  76. Palombo D, Lucertini G, Robaldo A, Pane B, Spinella G. Treatment of penetrating aortic ulcer by endoprosthesis: a single center experience. Int Angiol. 2011.

  77. Czerny M, Funovics M, Sodeck G, Dumfarth J, Schoder M, Juraszek A, et al. Results after thoracic endovascular aortic repair in penetrating atherosclerotic ulcers. Ann Thorac Surg. 2011;92(2):562–6 discussion 6-7.

    Article  PubMed  Google Scholar 

  78. Mestres G, Rodriguez R, Garcia-Madrid C, Montana X, Burrel M, Cruz LF, et al. Endovascular treatment of penetrating aortic ulcers: mid-term follow-up. Rev Esp Cardiol (Engl Ed). 2012;65(1):54–9.

    Article  Google Scholar 

  79. Georgiadis GS, Trellopoulos G, Antoniou GA, Georgakarakos EI, Nikolopoulos ES, Pelekas D, et al. Endovascular therapy for penetrating ulcers of the infrarenal aorta. ANZ J Surg. 2013;83(10):758–63.

    PubMed  Google Scholar 

  80. Monnin-Bares V, Thony F, Rodiere M, Bach V, Hacini R, Blin D, et al. Endovascular stent-graft management of aortic intramural hematomas. J Vasc Interv Radiol. 2009;20(6):713–21.

    Article  PubMed  Google Scholar 

  81. Manning BJ, Dias N, Manno M, Ohrlander T, Malina M, Sonesson B, et al. Endovascular treatment of acute complicated Type B dissection: morphological changes at midterm follow-up. J Endovasc Ther. 2009;16(4):466–74.

    Article  PubMed  Google Scholar 

  82. Li DL, Zhang HK, Cai YY, Jin W, Chen XD, Tian L, et al. Acute Type B aortic intramural hematoma: treatment strategy and the role of endovascular repair. J Endovasc Ther. 2010;17(5):617–21.

    Article  PubMed  Google Scholar 

  83. Lavingia KS, Ahanchi SS, Redlinger RE, Udgiri NR, Panneton JM. Aortic remodeling after thoracic endovascular aortic repair for intramural hematoma. J Vasc Surg. 2014;60(4):929–35 (discussion 35-6).

    Article  PubMed  Google Scholar 

  84. Bischoff MS, Meisenbacher K, Wehrmeister M, Bockler D, Kotelis D. Treatment indications for and outcome of endovascular repair of Type B intramural aortic hematoma. J Vasc Surg. 2016;64(6):1569–79.

    Article  PubMed  Google Scholar 

  85. Koullias GJ, Wheatley GH 3rd. State-of-the-art of hybrid procedures for the aortic arch: a meta-analysis. Ann Thorac Surg. 2010;90(2):689–97.

    Article  PubMed  Google Scholar 

  86. Huang Q, Chen XM, Yang H, Lin QN, Qin X. Effect of left subclavian artery revascularisation in thoracic endovascular aortic repair: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2018;56(5):644–51.

    Article  PubMed  Google Scholar 

  87. Redlinger RE Jr, Ahanchi SS, Panneton JM. In situ laser fenestration during emergent thoracic endovascular aortic repair is an effective method for left subclavian artery revascularization. J Vasc Surg. 2013;58(5):1171–7.

    Article  PubMed  Google Scholar 

  88. Patel HJ, Dake MD, Bavaria JE, Singh MJ, Filinger M, Fischbein MP, Williams DM, Matsumura JS, Oderich G. Branched endovascular therapy of the distal aortic arch: preliminary results of the feasibility multicenter trial of the gore thoracic branch endoprosthesis. Ann Thorac Surg. 2016;102(4):1190–8.

    Article  PubMed  Google Scholar 

  89. Feezor RJ, Martin TD, Hess PJ Jr, Daniels MJ, Beaver TM, Klodell CT, et al. Extent of aortic coverage and incidence of spinal cord ischemia after thoracic endovascular aneurysm repair. Ann Thorac Surg. 2008;86(6):1809–14 (discussion 14.s).

    Article  PubMed  Google Scholar 

  90. Banga PV, Oderich GS, Reis de Souza L, Hofer J, Cazares Gonzalez ML, Pulido JN, Cha S, Gloviczki P. Neuromonitoring, cerebrospinal fluid drainage, and selective use of iliofemoral conduits to minimize risk of spinal cord injury during complex endovascular aortic repair. J Endovasc Ther. 2016;23(1):139–49.

    Article  PubMed  Google Scholar 

  91. Dijkstra ML, Vainas T, Zeebregts CJ, Hooft L, van der Laan MJ. Editor’s choice—spinal cord ischaemia in endovascular thoracic and thoraco-abdominal aortic repair: review of preventive strategies. Eur J Vasc Endovasc Surg. 2018;55(6):829–41.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Mayo Clinic Aortic Center and Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA

    Gustavo S. Oderich, Jussi M. Kärkkäinen, Emanuel R. Tenorio & Giuliano A. Sandri

  2. Division of Vascular and Endovascular Surgery, Washington University in St. Louis, Saint Louis, MO, USA

    Nanette R. Reed

  3. Gonda Vascular Center, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA

    Gustavo S. Oderich

Authors
  1. Gustavo S. Oderich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jussi M. Kärkkäinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nanette R. Reed
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emanuel R. Tenorio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giuliano A. Sandri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gustavo S. Oderich.

Ethics declarations

Conflict of interest

Dr. Oderich has received consulting fees and grants from Cook Medical, W. L. Gore and GE Healthcare (all paid to Mayo Clinic with no personal income). The other authors have no conflict of interests to disclose.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors. IRB approval was not needed. For this type of study, informed consent is not required. For this type of study, consent for publication is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oderich, G.S., Kärkkäinen, J.M., Reed, N.R. et al. Penetrating Aortic Ulcer and Intramural Hematoma. Cardiovasc Intervent Radiol 42, 321–334 (2019). https://doi.org/10.1007/s00270-018-2114-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-018-2114-x

Keywords

Search

Navigation