CardioVascular and Interventional Radiology

, Volume 42, Issue 3, pp 321–334 | Cite as

Penetrating Aortic Ulcer and Intramural Hematoma

  • Gustavo S. OderichEmail author
  • Jussi M. Kärkkäinen
  • Nanette R. Reed
  • Emanuel R. Tenorio
  • Giuliano A. Sandri


Acute aortic syndromes include a variety of overlapping clinical and anatomic diseases. Penetrating aortic ulcer (PAU), intramural hematoma (IMH) and aortic dissection can occur as isolated processes or can be found in association. All these entities are potentially life threatening, so prompt diagnosis and treatment is of paramount importance. PAU and IMH lesions in the Stanford Type A distribution often require urgent open surgical repair. Lesions in the Stanford Type B distribution may be managed medically in the absence of symptoms or progression; however, a low threshold for endovascular or surgical treatment should be maintained. This review summarizes the clinical presentation, epidemiology, diagnosis, indications for treatment and endovascular strategies in patients with PAU or IMH.


Penetrating aortic ulcer Intramural hematoma Acute aortic syndrome 


Compliance with Ethical Standards

Conflict of interest

Dr. Oderich has received consulting fees and grants from Cook Medical, W. L. Gore and GE Healthcare (all paid to Mayo Clinic with no personal income). The other authors have no conflict of interests to disclose.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors. IRB approval was not needed. For this type of study, informed consent is not required. For this type of study, consent for publication is not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • Gustavo S. Oderich
    • 1
    • 3
    Email author
  • Jussi M. Kärkkäinen
    • 1
  • Nanette R. Reed
    • 2
  • Emanuel R. Tenorio
    • 1
  • Giuliano A. Sandri
    • 1
  1. 1.Mayo Clinic Aortic Center and Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular SurgeryMayo ClinicRochesterUSA
  2. 2.Division of Vascular and Endovascular SurgeryWashington University in St. LouisSaint LouisUSA
  3. 3.Gonda Vascular CenterMayo ClinicRochesterUSA

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