Aortic Remodeling in Patients Undergoing Endovascular Repair for Penetrating Aortic Ulcer With High-Risk Features.

Background: The natural history of penetrating aortic ulcers (PAUs) with high-risk radiologic features after thoracic endovascular aortic repair (TEVAR) remains incompletely characterized. This study assessed aortic remodeling and midterm outcomes after TEVAR for such lesions. Methods: We retrospectively reviewed patients undergoing TEVAR for high-risk PAUs between 2016 and 2022. Of 220 TEVAR cases, 12 patients (5.5%) met inclusion criteria with appropriate follow-up. Aortic remodeling was assessed per current societal guidelines. Results: The cohort included 8 men (66%) with a median age of 73 years and a median follow-up of 31 months (interquartile range, 12.75-59 months). Most PAUs (58%) were located in zone 3; 33% had multiple ulcers, often with >1 high-risk feature. Pre- and post-TEVAR main PAU + intramural hematoma depth averaged 10.1 ± 4.5 mm and 10.1 ± 8.1 mm, respectively. Aortic diameter increased from 41.3 ± 6.0 mm to 45.3 ± 10.4 mm. Complete thrombosis of the main PAU was observed in 92% of patients. Aortic remodeling was positive in 25% and stable in 58% of cases. No 30-day mortality occurred; however, 3 patients (25%) died of nonaortic causes during follow-up. Two reinterventions (17%) were performed for type 2 endoleak and new PAU formation due to cocaine use. Conclusions: TEVAR for PAUs with high-risk features results in complete thrombosis in most cases. Whereas positive aortic remodeling occurred in a subset, most patients experienced stabilization of aortic dimensions during midterm follow-up.