Short- and long-term efficacy of endovascular repair and medical treatment of penetration aortic ulcer

AIM To evaluate the short- and long-term clinical efficacy of endovascular repair (EVAR) and medical treatment (MT) in penetration aortic ulcer (PAU). METHODS Eighty-five PAU patients diagnosed from March 2006 to March 2014 were divided into EVAR group in which 47 patients received EVAR plus MT and MT group in which 38 patients received MT only. Short- and long-term clinical events including limb ischemia, paraplegia, renal failure, cerebral ischemia, dissection and death were evaluated in both groups. RESULTS In EVAR group, EVAR was successful in all 47 cases, and no endoleaks, stent migration, aortic rupture and cerebral ischemia occurred during operation. During the 30-day in-hospital follow-up, no negative events including paraplegia, cerebral ischemia and death occurred. The rate of limb ischemia and renal failure in EVAR group was lower than in the MT group, but no significant difference was observed between groups, (0 vs. 10%; 2% vs. 5%). However, the rate of dissection in the MT group was significantly higher than in the EVAR group (16% vs. 0, P=0.006). There was no statistical difference in the mean time of long-term follow-up between groups ［(34±22) months vs.(32±23) months; 87% vs. 82］. No paraplegia occurred, but the cumulative events of limb ischemia and renal failure in MT group were higher (16% vs. 2%; 13% vs. 5%). No statistical difference was found in the cumulative mortality and rupture rate between groups; however, these events in EVAR group were lower than those in MT group (5% vs. 13%; 2% vs. 7%). CONCLUSION Compared with MT alone, endovascular repair can decrease cumulative morality and rate of dissection in treatment of penetration aortic ulcer.