Penetrating Atherosclerotic Ulcer

Penetrating atherosclerotic ulcers are atherosclerotic lesions of the aorta that penetrate the internal elastic lamina and allow hematoma formation within the media of the aortic wall. The large majority of such ulcerations occur in the descending thoracic aorta, but less often they may occur in the arch or, rarely, in the ascending aorta. The ulcers may progress to form aortic pseudoa-neurysms or, less often, lead to transmural aortic rupture. Table 1.4 summarizes the collective demographics from three series of patients with of intramural hematoma. Those in whom penetrating atherosclerotic ulcers develop tend to be elderly and are on average about a decade older that those who present with typical aortic dissection. Most have a history of hypertension and smoking. They tend to have severe and extensive atherosclerosis; the majority have evidence of other atherosclerotic cardiovascular disease and as many as half also have a history of a preexisting abdominal or thoracic aortic aneurysm.

References

1. Clouse WD, Hallett JW Jr, Schaff HV, Gayari MM, Ilstrup DM, Melton LJ 3rd (1998). Improved prognosis of thoracic aortic aneurysms: a population-based study. JAMA 280, 1926-1929.

2. Isselbacher EM (2004). Diseases of the aorta. In Braunwald E, Zipes DP, Libby P, Bonow RO (Eds). Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 7th edition. WB Saunders, Philadelphia.

3. Guo D, Hasham S, Kuang S-Q, et al. (2001). Familial thoracic aortic aneurysms and dissections. Circulation 103, 2461-2468.

4. Nistri S, Sorbo MD, Marin M, et al. (1999). Aortic root dilatation in young men with normally functioning bicuspid aortic valves. Heart 82, 19-22.

5. DeSa M, Moshkovitz Y, Butany J, David TE (1999). Histologic abnormalities of the ascending aorta and pulmonary trunk in patients with bicuspid aortic valve disease: clinical relevance to the Ross procedure. J. Thorac. Cardiovasc. Surg. 118, 588-596.

6. Huntington K, Hunter AG, Chan KL (1997). A prospective study to assess the frequency of familial clustering of congenital bicuspid aortic valve. J. Am. Coll. Cardiol. 30, 1809-1812.

7. Coady MA, Davis RR, Roberts M, et al. (1999). Familial patterns of thoracic aortic aneurysms. Arch. Surg. 134, 361-367.

8. Biddinger A, Rocklin M, Coselli J, Milewicz DM (1997). Familial thoracic aortic dilatations and dissections: a case control study. J. Vasc. Surg. 25, 506-511.

9. Milewicz DM, Chen H, Park E-S, et al. (1998). Reduced penetrance and variable expressivity of familial thoracic aneurysms/dissections. Am. J. Cardiol. 82, 474-479.

10. Vaughan CJ, Casey M, He J, et al. (2001). Identification of a chromosome 11q23.2-q24 locus for familial aortic aneurysm disease, a genetically heterogeneous disorder. Circulation 103, 2469-2475.

11. Guo D, Hasham S, Kuang S-Q, et al. (2001). Familial thoracic aortic aneurysms and dissections. Circulation 103, 2461-2468.

12. Davies RR, Goldstein LJ, Coady MA, Tittle SL, et al. (2002). Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann. Thorac. Surg. 73, 17-28.

13. Griepp RB, Ergin A, Gall JD, et al. (1999). Natural history of descending thoracic and thoracoabdominal aneurysms. Ann. Thorac. Surg. 67, 1927-1930.

14. Dapunt OE, Galla JD, Sadeghi AM, et al. (1994). The natural history of thoracic aortic aneurysms. J. Thorac. Cardiovasc. Surg. 107, 1323.

15. Meszaros I, Morocz J, Szlavi J, et al. (2000). Epidemiology and clinicopathology of aortic dissection: a population-based longitudinal study over 27 years. Chest 117, 1271-1278.

16. Nienaber CA, Fattori R, Mehta RH, Richartz BM, Evangelista A, Petzsch M, Cooper JV, Januzzi JL, Ince H, Sechtem U, Bossone E, Fang J, Smith D, Isselbacher EM, Pape LA, Eagle KA, on behalf of the International Registry of Acute Aortic Dissection (2004). Gender-related differences in acute aortic dissection. Circulation 109, 3014-3021.

17. Januzzi JL, Isselbacher EM, Fattori R, et al. (2004). Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD). J. Am. Coll. Cardiol. 43, 665-669.

18. Eagle KA, Isselbacher EM, DeSanctis W (2002). Cocaine-related aortic dissection in perspective. Circulation 105, 1529-1530.

19. Januzzi JL, Sabatine MS, Eagle KA, Evangelista A, Bruckman D, Fattori R, Oh JK, Moore AG, Sechtem U, Llovet A, Gilon D, Pape L, O'Gara PT, Mehta R, Cooper JV, Hagan PG, Armstrong WF, Deeb GM, Suzuki T, Nienaber CA, Isselbacher EM (2002). Iatrogenic aortic dissection. Am. J. Cardiol. 89, 623-626.

20. Mehta RH, Manfredini R, Hassan F, Sechtem U, Bossone E, Oh JK, Cooper JV, Smith DE, Portaluppi F, Penn M, Hutchison S, Nienaber CA, Isselbacher EM, Eagle KA (2002). Chronobiological patterns of acute aortic dissection. Circulation 106, 1110-1115.

21. Evangelista A, Mukherjee D, Mehta RH, O'Gara PT, Fattori R, Cooper JV, Smith DE, Oh JK, Hutchison S, Sechtem U, Isselbacher EM, Nienaber CA, Pape LA, Eagle KA, for the International Registry of Aortic Dissection (IRAD) Investigators (2005). Acute intramural hematoma of the aorta: a mystery in evolution. Circulation 111, 1063-1070.

22. Von Kodolitsch Y, Csosz SK, Koschyk DH, et al. (2003). Intramural hematoma of the aorta: predictors of progression to dissection and rupture. Circulation 107, 1158-1163.

23. Ganaha F, Miller DC, Sugimoto K, et al. (2002). Prognosis of aortic intramural hematoma with and without penetrating atherosclerotic ulcer: a clinical and radiological analysis. Circulation 106, 342-348.

24. Coady MA, Rizzo JA, Hammond GL, Pierce JG, Kopf GS, Elefteriades JA (1998). Penetrating ulcer of the thoracic aorta: How do we recognize it? How do we manage it? J. Vasc. Surg. 27, 1006-1016.

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