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Prognostication of Asymptomatic Penetrating Aortic Ulcers: A Modern Approach.

Publication ,  Journal Article
DeCarlo, C; Latz, CA; Boitano, LT; Kim, Y; Tanious, A; Schwartz, SI; Patell, R; Mohebali, J; Dua, A
Published in: Circulation
October 5, 2021

BACKGROUND: Literature detailing the natural history of asymptomatic penetrating aortic ulcers (PAUs) is sparse and lacks long-term follow-up. This study sought to determine the rate of asymptomatic PAU growth over time and adverse events from asymptomatic PAU. METHODS: A cohort of patients with asymptomatic PAU from 2005 to 2020 was followed. One ulcer was followed per patient. Primary end points were change in size over time and the composite of symptoms, radiographic progression, rupture, and intervention; cumulative incidence function estimated the incidence of the composite outcome. Ulcer size and rate of change were modeled using a linear mixed-effects model. Patient and anatomic factors were evaluated as potential predictors of the outcomes. RESULTS: There were 273 patients identified. The mean age was 75.5±9.6 years; 66.4% were male. The majority of ulcers were in the descending thoracic aorta (53.9%), followed by abdominal aorta (41.4%) and aortic arch (4.8%). Fusiform aneurysmal disease was present in 21.6% of patients at a separate location; 2.6% had an associated intramural hematoma; 23.6% had at least 1 other PAU. Symptoms developed in 1 patient who ruptured; 8 patients (2.9%) underwent an intervention for PAU (1 for rupture, 2 for radiographic progression, 5 for size/growth) at a median of 3.1 years (interquartile range, 1.0-6.5) after diagnosis. Five- and 10-year cumulative incidence of the primary outcome, adjusted for competing risk of death, was 3.6% (95% CI, 1.6%-6.9%) and 6.5% (95% CI, 3.1%-11.4%), respectively. For 191 patients with multiple computed tomography scans (760 total computed tomographies) with a median radiographic follow-up of 3.50 years (interquartile range, 1.20-6.63 years), mean initial ulcer width, ulcer depth, and total diameter were 13.6 mm, 8.5 mm, and 31.4 mm, respectively. A small but statistically significant change over time was observed for ulcer width (0.23 mm/y) and total diameter (0.24 mm/y); ulcer depth did not significantly change over time. Hypertension, hyperlipidemia, diabetes, initial ulcer width >20 mm, thrombosed PAU, and associated saccular aneurysm were associated with larger changes in ulcer size over time; however, the magnitude of difference was small, ranging from 0.4 to 1.9 mm/y. CONCLUSIONS: Asymptomatic PAU displayed minimal growth and infrequent complications including rupture. Asymptomatic PAU may be conservatively managed with serial imaging and risk factor modification.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

October 5, 2021

Volume

144

Issue

14

Start / End Page

1091 / 1101

Location

United States

Related Subject Headings

  • Ulcer
  • Risk Factors
  • Prognosis
  • Male
  • Humans
  • Female
  • Cardiovascular System & Hematology
  • Aorta, Abdominal
  • Aged
  • 4207 Sports science and exercise
 

Citation

APA
Chicago
ICMJE
MLA
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DeCarlo, C., Latz, C. A., Boitano, L. T., Kim, Y., Tanious, A., Schwartz, S. I., … Dua, A. (2021). Prognostication of Asymptomatic Penetrating Aortic Ulcers: A Modern Approach. Circulation, 144(14), 1091–1101. https://doi.org/10.1161/CIRCULATIONAHA.121.054710
DeCarlo, Charles, Christopher A. Latz, Laura T. Boitano, Young Kim, Adam Tanious, Samuel I. Schwartz, Rushad Patell, Jahan Mohebali, and Anahita Dua. “Prognostication of Asymptomatic Penetrating Aortic Ulcers: A Modern Approach.Circulation 144, no. 14 (October 5, 2021): 1091–1101. https://doi.org/10.1161/CIRCULATIONAHA.121.054710.
DeCarlo C, Latz CA, Boitano LT, Kim Y, Tanious A, Schwartz SI, et al. Prognostication of Asymptomatic Penetrating Aortic Ulcers: A Modern Approach. Circulation. 2021 Oct 5;144(14):1091–101.
DeCarlo, Charles, et al. “Prognostication of Asymptomatic Penetrating Aortic Ulcers: A Modern Approach.Circulation, vol. 144, no. 14, Oct. 2021, pp. 1091–101. Pubmed, doi:10.1161/CIRCULATIONAHA.121.054710.
DeCarlo C, Latz CA, Boitano LT, Kim Y, Tanious A, Schwartz SI, Patell R, Mohebali J, Dua A. Prognostication of Asymptomatic Penetrating Aortic Ulcers: A Modern Approach. Circulation. 2021 Oct 5;144(14):1091–1101.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

October 5, 2021

Volume

144

Issue

14

Start / End Page

1091 / 1101

Location

United States

Related Subject Headings

  • Ulcer
  • Risk Factors
  • Prognosis
  • Male
  • Humans
  • Female
  • Cardiovascular System & Hematology
  • Aorta, Abdominal
  • Aged
  • 4207 Sports science and exercise