TEVAR in а patient with penetrating thoracic aortic ulcer, complicated by an aortoesophageal fistula

Abstract

The penetrating aortic ulcer (PAU) is one of the subtypes of the acute aortic syndrome. Theetiology of PAU is linked to the etiopathogenesis of atherosclerosis and it is observed in elderly patientswith risk factors such as arterial hypertension, hyperlipidemia, smoking, coronary artery disease. For firsttime PAU is defined by Stanson and colleagues in 1986 as ulcerating of an atherosclerotic aortic plaque,penetrating through lamina elastica and reaching tunica media. This weakens and thins the aortic wall andresults in dilation. The latter is observed in more than 50% of the cases. It is specific for thoracic segmentsof the aorta and leads to the formation of aneurysms. The endovascular treatment with implantationof endoprosthesis in the thoracic aorta (TEVAR) is a method of choice for treatment of PAU (class ofrecommendation IIa, level of evidence C), according to the European recommendations. In 1998 PAUwas treated with TEVAR for the first time. Since then, there are many reports for successful endovasculartreatment of this disease. Penetration of the aortic ulcer to the esophagus and subsequently formationof aortoesophageal fistula (AEF) is extremely rare and life-threatening condition with very high rates ofmortality. In the present clinical case, we present an elderly man with risk factors for atherosclerosiswith a proven penetrating aortic ulcer, complicated with AEF. The patient was treated with endovascularimplantation of two endoprostheses in the thoracic aorta and placement of a Sengstaken-Blakmore tube.