CASE REPORT Penetrating Atherosclerotic Ulcer of the Abdominal Aorta Involving the Celiac Trunk Origin and Superior Mesenteric Artery Occlusion: Endovascular Treatment Carlo Ferro • Umberto G. Rossi • Francesco Petrocelli • Sara Seitun • Alessandro Robaldo • Raffaele Mazzei Received: 27 September 2010 / Accepted: 28 October 2010 / Published online: 20 November 2010 Ó Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2010 Abstract We describe a case of endovascular treatment in a 64-year-old woman affected by a penetrating athero- sclerotic ulcer (PAU) of the abdominal aorta with a 26-mm pseudoaneurysm involving the celiac trunk (CT) origin and with superior mesenteric artery (SMA) occlusion in the first 30 mm. The patient underwent stenting to treat the SMA occlusion and subsequent deployment of a custom- designed fenestrated endovascular stent-graft to treat the PAU involving the CT origin. Follow-up at 6 months after device placement demonstrated no complications, and there was complete thrombosis of the PAU and patency of the two branch vessels. Keywords Aorta Á Penetrating atherosclerotic ulcer Á Superior mesenteric artery Á Endovascular treatment Introduction Endovascular stent-graft repair is a valid treatment option for patients with abdominal aortic pathologies. This minimally invasive option offers patients a treatment with lower mor- bidity and mortality rates than conventional open surgery [1]. Nevertheless, the primary limitations to successful endo- vascular stent-graft repair are unfavorable anatomy, inade- quate working length, and aortic pathology that includes branch vessels [2]. Since 1999, fenestrated endografting and, subsequently, branched techniques have emerged as poten- tial solutions to many of the problems limiting the success of endovascular stent-graft repair [3–5]. In this report, we describe endovascular treatment of an uncommon case of penetrating atherosclerotic ulcer (PAU) of the abdominal aorta with a pseudoaneurysm involving the celiac trunk (CT) origin and with superior mesenteric artery (SMA) occlusion. Case Report A 64 year-old woman, with a history of smoking, severe chronic obstructive pulmunary disease, chronic hyperten- sion, and chronic heart failure was referred to the emer- gency room with upper abdominal and back pain. The physical examination was unremarkable expect for high arterial blood pressure (160 mmHg systolic, 90 mmHg diastolic). According to the American Society of Anesthe- siologists classification, the patient was considered to have a ‘‘grade III preoperative risk.’’ A contrast-enhanced mul- tidetector computed tomography angiography (MDCTA) scan was then performed, which demonstrated the presence of a PAU with a 26-mm pseudoaneurysm involving the CT origin (7 mm in diameter) and with SMA occlusion of the first 30 mm (Fig. 1). After multidisciplinary consultation, a two-stage endo- vascular treatment was chosen: (1) stent placement for the SMA occlusion and (2) placement of a custom-designed fenestrated endovascular stent-graft for exclusion of the PAU with pseudoaneurysm involving the CT origin. Written informed consent was obtained from the patient. Procedures were performed in a dedicated hybrid angiog- raphy suite with the use of high-resolution imaging (Axiom Artis FA; Siemens, Enlargen, Germany). C. Ferro Á U. G. Rossi (&) Á F. Petrocelli Á S. Seitun Department of Diagnostic and Interventional Radiology, San Martino University Hospital, 16132 Genoa, Italy e-mail: urossi76@hotmail.com A. Robaldo Á R. Mazzei Department of Vascular Surgery, San Martino University Hospital, 16132 Genoa, Italy 123 Cardiovasc Intervent Radiol (2011) 34:S40–S43 DOI 10.1007/s00270-010-0041-6