Commentary on “Medical and Surgical Management of a Descending Aorta Penetrating Atherosclerotic Ulcer and Associated Ascending Intramural Hematoma” by Henn, M.C. et al.

[摘要] Henn et al. [1] have nicely described a case scenario whereby a penetrating atherosclerotic ulcer (PAU) of the descending aorta extends with intramural hematoma (IMH) into the ascending aorta. For those of us who manage a lot of acute aortic pathology, this clinical scenario occurs not that infrequently. Based on the dictum that all type A pathology is treated first, the question is whether these patients should be managed by replacement of their ascending aorta first with subsequent repair of their PAU at a later date. Should the ascending be repaired and then insert an endograft distally in an open technique in the same setting? Or should we do as the authors have suggested: just treat the PAU with a covered stent endograft in the descending thoracic aorta? Surprisingly, there is little literature or data to help us manage this clinical scenario.