Penetrating atherosclerotic ulcer

Penetrating atherosclerotic ulcer (PAU) is a type of atherosclerotic disease that affects the aorta, the main blood vessel in the body. It is characterized by the ulceration of an atherosclerotic plaque that penetrates through the internal elastic lamina into the media of the aortic wall.

Etiology

The exact cause of PAU is not known, but it is believed to be related to the weakening of the aortic wall due to atherosclerosis. This can lead to the formation of an ulcer, which can then penetrate into the aortic wall. Risk factors for PAU include hypertension, smoking, and hyperlipidemia.

Pathophysiology

In PAU, the atherosclerotic plaque ulcerates and penetrates through the internal elastic lamina into the media of the aortic wall. This can lead to the formation of a hematoma, which can cause the aortic wall to bulge outwards. If the hematoma ruptures, it can lead to a dissection or aneurysm of the aorta.

Clinical Presentation

Patients with PAU often present with severe chest or back pain, similar to that of an aortic dissection. Other symptoms may include syncope, dyspnea, and abdominal pain. PAU can be diagnosed through imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI).

Treatment

The treatment of PAU depends on the location and size of the ulcer, as well as the patient's overall health. Treatment options may include medical management, endovascular repair, or open surgical repair. Medical management typically involves the use of medications to control blood pressure and cholesterol levels. Endovascular repair involves the placement of a stent graft in the aorta, while open surgical repair involves the removal of the diseased portion of the aorta and replacement with a graft.

Prognosis

The prognosis of PAU is variable and depends on the size and location of the ulcer, as well as the patient's overall health. With appropriate treatment, the prognosis can be favorable.

See Also

• Atherosclerosis
• Aortic dissection
• Aortic aneurysm

Penetrating atherosclerotic ulcer Resources
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