**Author details**

Jennifer Schwartz1 , David E. Lindsey1,2, Hooman Khabiri3 and Stanislaw P. A. Stawicki1,2

1 Department of Surgery, The Ohio State University College of Medicine, Columbus Ohio, USA

2 Division of Critical Care Trauma and Burn, The Ohio State University College of Medicine, Columbus Ohio, USA

3 Department of Radiology, Section of Interventional Radiology, The Ohio State University College of Medicine, Columbus Ohio, USA

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**Section 3**

**Great-Vessel Surgery**

**Great-Vessel Surgery**

**Chapter 15**

**Penetrating Aortic Ulcers**

Additional information is available at the end of the chapter

Penetrating aortic ulcers were initially described by Shennan in 1934 [1]. Shumacker and King reported the first operative repair of a ruptured descending aorta secondary to a penetrating aortic ulcer in 1959 [2]. The clinical and pathologic entity of penetrating aortic ulcers was not established, however, until 1986 by Stanson [3]. Since that time, the body of literature on this disease has increased significantly. This chapter provides a broad overview of penetrating

Acute aortic syndromes are a group of disease entities that include penetrating aortic ulcers in addition to aortic dissections and intramural hematomas. Aortic dissections are defined by a tear of the intima that results in passage of blood and separation of the intimal and medial or adventitial layers of the vessel wall (Figure 1) [4]. This typically occurs in patients with cystic medial necrosis or medial degeneration. This creates a false lumen, and propagation of the tear either antegrade or retrograde can result in aortic valve insufficiency, cardiac tamponade, and/ or organ malperfusion [5]. Intramural hematomas are caused by rupture of the vaso vasorum. This leads to hemorrhage within the aortic media, and can subsequently lead to rupture of the aortic wall or inward disruption of the intima with resultant secondary aortic dissection [6,7].

As the name suggests, penetrating aortic ulcers arise from atheromatous plaques that ulcerate, causing disruption of the internal elastic lamina [6]. Erosion into the medial layer can lead to development of an intramural hematoma or dissection, complications that can eventually lead to pseudoaneurysm formation or aortic rupture. Penetrating aortic ulcers tend to occur in patients with advanced atherosclerosis. Furthermore, they can occur in isolation or in multiples

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© 2013 Kilic and Kilic; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

Arman Kilic and Ahmet Kilic

http://dx.doi.org/10.5772/54107

**1. Introduction**

aortic ulcers.

**2. Pathophysiology**

**Chapter 15**
