Penetrating atherosclerotic ulcer Mx with thoracic endovascu
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Penetrating atherosclerotic ulcer (PAU) is defined as ulceration of an aortic atherosclerotic plaque penetrating through the internal elastic lamina into the media. PAU is at risk of intramural hematoma, pseudoaneurysm, aortic rupture, or an acute aortic dissection.

The following case has been reported in the journal Circulation. An 87-year-old woman was referred for an 11-day history of continuous abdominal pain, left lower chest pain, and back pain. The patient had a history of hypertension and stable angina. Her medication consisted of an angiotensin-converting enzyme inhibitor and β-blocker. Antiplatelet was stopped after the development of chronic subdural hematoma 3 years before admission, and anticoagulation was not prescribed.

Her physical examination was unremarkable except for a blood pressure of 158/103 mm Hg. Electrocardiography showed normal recordings. A contrast-enhanced chest computed tomography scan showed a narrow-necked, contrast-filled outpouching of the descending thoracic aorta. The dimensions of the ascending and descending aorta were normal.

On the basis of these findings, PAU was suspected. She was admitted to the hospital, and a calcium channel blocker was added with resolution of symptoms within 1 day. Her systolic blood pressure was controlled below 120 mm Hg. A week later, she again developed significant back pain. Follow-up computed tomography revealed an expansion of the PAU and intramural hematoma.

Urgent thoracic endovascular aortic repair with Gore CTAG 3110 was performed. Neither antiplatelet nor anticoagulation was prescribed after stent placement. Postoperative chest computed tomography showed resolution of the PAU and intramural hematoma. The patient subsequently recovered and was discharged uneventfully 14 days later.

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