Penetrating atherosclerotic ulcers of the aorta

Background: Penetrating aortic ulcers burrow into the aortic wall and can have fatal consequences. Although they were first described as long ago as 1934 they have only recently been recognized as a distinct pathological entity. Method: A review of the current literature was undertaken, based primarily on an English language Medline search with secondary references obtained from key articles. Results: Penetrating aortic ulcer is principally a disease of elderly hypertensive men. It may run a benign course or may produce complications such as aortic rupture, embolization and aneurysm formation. Presentation may be identical to that of classical aortic dissection, but the distinction is important because an ulcer may be more likely to cause rupture. Conclusion: Open surgical repair has been the 'gold standard' of treatment but endovascular stenting is an attractive option in this group of frail patients.