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.


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