Twelve-Month Clinical Outcomes Following TEVAR for Acute Type B Aortic PAUs

Overview

This study evaluates the 12-month clinical outcomes and 6-month morphological changes in patients with acute penetrating aortic ulcers (PAUs) treated with thoracic endovascular aortic repair (TEVAR) and antiplatelet therapy. The findings suggest that antiplatelet therapy may be safe, with no significant differences in major adverse events between patients receiving and not receiving such therapy.

Background

Penetrating aortic ulcers (PAUs) represent a critical subset of acute aortic syndrome, accounting for 2%-7% of cases. They can lead to severe complications, including aortic rupture and dissection. TEVAR has emerged as an effective treatment modality, yet the role of antiplatelet therapy in this context remains underexplored, necessitating further investigation into its safety and efficacy.

Data Highlights

Key Findings

• Of 195 patients, 59 received antiplatelet therapy (AP group) and 136 did not (NAP group).
• At 6 months, significant reductions in PAU diameter and depth were observed in both groups (P < 0.001).
• During the 12-month follow-up, 15.8% of patients experienced a primary outcome event.
• Cumulative incidence of major adverse events was higher in the AP group compared to the NAP group, but not statistically significant.
• Maximum aortic diameter, PAU diameter ≥ 10.5 mm, and PAU depth ≥ 7.5 mm were associated with major adverse events.

Clinical Implications

The study indicates that antiplatelet therapy may be safely administered to patients undergoing TEVAR for acute PAUs. Clinicians should consider the morphological parameters associated with adverse events when managing these patients.

Conclusion

The findings support the safety of antiplatelet therapy in the context of TEVAR for acute PAUs, while highlighting specific anatomical features that may predict adverse outcomes.

Related Resources & Content

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4. European Society for Vascular Surgery (ESVS) 2026 Clinical Practice Guidelines on the Management of Descending Thoracic and Thoraco-Abdominal Aortic Diseases – Editor's Choice
5. International Expert Consensus on the Management of Acute Aortic Type B Intramural Haematoma and Penetrating Ulcer - ScienceDirect
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9. International Expert Consensus on the Management of Acute Aortic Type B Intramural Haematoma and Penetrating Ulcer - ScienceDirect
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11. Penetrating Aortic Ulcers and Pseudoaneurysms Managed with Endovascular Aortic Arch Repair - PubMed
12. Optimal antiplatelet therapy after revascularization of left subclavian artery during TEVAR | Journal of Cardiothoracic Surgery | Springer Nature Link