Penetrating atherosclerotic ulcers of the descending thoracic aorta may be managed expectantly

The natural history of penetrating atherosclerotic ulcers (PAUs) of the descending thoracic aorta remains unclear. Between January 1996 and June 2000, PAU was diagnosed in 36 patients (16 men, 20 women; mean age 74.9 ± 1.5 years) at Washington University. Imaging studies and hospital records were reviewed. Late follow-up was by search of the Social Security Death Index and telephone interview. None of 16 asymptomatic patients underwent operation. At follow-up (median 457 days), 6 patients had died of unrelated and 2 of unknown causes. Among 20 symptomatic patients, 10 had associated intramural hematoma (5) or dissection (5), of whom 3 underwent operation. At median follow-up (448 days), the 7 unoperated patients remained alive without an aortic operation. Among the remaining 10 symptomatic patients, 3 had an aortic operation and 2 died of unknown causes during follow-up (median 586 days). These data suggest that, in selected cases, PAU may be managed expectantly with careful observation.