Department of Cardiovascular Medicine, Division of Cardiac Surgery, Catholic University, Rome, Italy.
J Cardiovasc Med (Hagerstown). 2010 Nov;11(11):815-9. doi: 10.2459/JCM.0b013e32833cdb96.
Penetrating ulcer of the aorta has been recognized as a distinct aortic disorder, defined by the ulceration of an atherosclerotic plaque. The lesion has the potential to evolve acutely into aortic rupture, but chronic pictures are possible. Late evolution into rupture, frank aortic dissection and progressive aortic enlargement have been documented. We discuss different modalities of presentation on the basis of recent clinical cases. As the optimal treatment, either surgical (open or endovascular) or medical, is based on a correct diagnosis, we highlight the importance of including aortic ulcers in the differential diagnosis of chest pain. Although endovascular treatment can be advisable in cases with favorable anatomic condition and in patients with multiple comorbidities, the open surgical option should be available given the heterogeneous location and clinical scenarios of these lesions.
穿透性主动脉溃疡已被认为是一种明确的主动脉疾病，其特征为粥样斑块的溃疡。该病变有可能急性演变为主动脉破裂，但也可能为慢性表现。晚期可进展为破裂、真性主动脉夹层和主动脉进行性扩大。我们根据最近的临床病例讨论了不同的表现形式。由于正确的诊断是决定最佳治疗方案（手术或血管内治疗或药物治疗）的基础，因此我们强调在胸痛的鉴别诊断中应包括主动脉溃疡。尽管在解剖条件有利和合并多种合并症的患者中，血管内治疗可能是合理的，但鉴于这些病变的异质性位置和临床情况，应可选择开放手术。
