Is endovascular treatment of penetrating aortic ulcer the solution?

Almeida, Rui M. S.

doi:10.1590/S0066-782X2011000900013

LETTER TO THE EDITOR

Universidade Estadual do Oeste do Paraná - UNIOESTE; Faculdade Assis Gurgacz - FAG; Instituto de Moléstias Cardiovasculares do Oeste do Paraná - ICCOP, Paraná - Brazil

Mailing address

Keywords: Prosthesis implantation; aorta, thoracic; aortic diseases.

We commend the work by Tumelero et al¹, which reports the treatment of penetrating aortic ulcer (PAU) by endovascular technique. The description of cases and their form of treatment makes us think that this kind of treatment is the reference standard for this disease. The literature shows excellent results in this type of treatment, not only by the cessation of symptoms, but also for avoiding the risk of acute aortic dissection with increased morbidity and mortality.

In a multicenter study in Brazil², among 255 patients undergoing thoracic aortic stent implantation, eight patients had PAU (3.14%). Although our cases have undergone endoprosthesis placement, some words of caution should, however, be said: 1) the indication of treatment of PAU should be made only to patients with symptoms³; 2) the development of endoprostheses is not yet established² despite being a less aggressive treatment, with results similar to conventional surgery; 3) as the age group in this type of disease is high, and the disease may also be peripheral, an alternative access is necessary⁴; 4) follow-up by imaging studies is mandatory². This approach should therefore be seen as an alternative to conventional treatment, but also because of the short time of follow-up of endoprosthesis, it cannot be declared as a treatment of choice when compared to traditional surgery. Again, we congratulate the authors and appreciate the opportunity to comment on this study.

References

1. Tumelero RT, Duda NT, Tognon AP, Panata L, Teixeira JC, Giongo JB. Implante de endoprótese para tratamento de úlcera penetrante de aorta. Arq Bras Cardiol. 2011;96(2):e20-3.
2. Almeida RM, Leal JC, Saadi EK, Braile DM, Rocha AS, Volpiani G, et al. Thoracic endovascular aortic repair - a Brazilian experience in 255 patients over a period of 112 months. Interact Cardiovasc Thorac Surg. 2009;8(5):524-8.
3. Albuquerque LC, Braile DM, Palma JH, Saadi EK, Almeida RMS, Gomes WJ, et al. Diretrizes para o tratamento cirúrgico das doenças da aorta da Sociedade Brasileira de Cirurgia Cardiovascular - Atualização 2009. Rev Bras Cir Cardiovasc. 2009; 24(2 supl):7s-34s.
4. Saadi EK, Dussin LH, Moura L, Machado AS. The axillary artery--a new approach for endovascular treatment of thoracic aortic diseases. Interact Cardiovasc Thorac Surg. 2010;11(5):617-9.