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Read MoreAn aortic ulcer is a type of injury in the wall of the aorta, the main artery that carries blood from your heart to the rest of your body. It may start with mild symptoms, but if left untreated, it can become serious, making early diagnosis and management important.
What Is an Aortic Ulcer?
An aortic ulcer is a small, crater-like break in the inner lining (intima) of the aorta. It often develops where hardening of the arteries (atherosclerosis), has led to fatty plaque accumulation and weakened the aortic wall. Over time, blood pressure can force its way into this defect, creating a pocket that may deepen and extend into the middle layer of the aortic wall. If the ulcer progresses unchecked, it can cause an intramural hematoma, full-thickness dissection or rupture.
Types of Aortic Ulcer
There are several ways to classify aortic ulcers based on how deeply they penetrate and where they occur:
- Superficial intimal ulcer: Confined to the intima, with minimal risk of deep wall injury
- Penetrating atherosclerotic ulcer (PAU): Plaque erosion extends through the intima into the media, carrying a higher risk of hematoma or dissection
- Type A ulcer: Any ulcer involving the ascending aorta or aortic arch, often requiring more aggressive monitoring or surgery
- Type B ulcer: Located in the descending thoracic or abdominal aorta, usually managed first with medical therapy
Aortic Ulcer Risk Factors
Several factors can weaken the aortic wall and increase the likelihood of ulcer formation. Atherosclerosis from high cholesterol or long-term smoking creates rough spots where the inner lining can break down. Uncontrolled high blood pressure can add stress to the vessel wall, and natural age-related thinning of the aorta further reduces its resilience. Inherited connective tissue disorders also compromise the aorta’s strength, and trauma or some invasive procedures near the chest can sometimes trigger an ulcer.
What Are the Symptoms of an Aortic Ulcer?
Symptoms of an aortic ulcer can vary, but many people experience sudden, intense pain and signs of complications as the ulcer progresses, including:
- Abdominal pain
- Pain between the shoulder blades
- Shortness of breath or coughing
- Dizziness, lightheadedness or fainting
- Weakness or numbness in the legs
- Severe chest or back pain that may be sharp, stabbing or tearing in nature
- Rapid heart rate or low blood pressure, indicating potential bleeding or dissection beneath the ulcer
How Is an Aortic Ulcer Diagnosed?
Doctors diagnose an aortic ulcer using advanced imaging like CT angiography, which highlights the aorta and reveals ulcers or intramural blood collections. Magnetic resonance angiography (MRA) offers a radiation-free alternative using magnetic fields and contrast agents to produce high-resolution images of the aortic layers. MRI and transesophageal echocardiography (TEE) can also detect vessel wall problems and related complications.
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Aortic Ulcer Treatment Options
Medications
The first step in treatment is often managing blood pressure with medications such as beta blockers. Lowering the pressure in the aorta helps prevent the ulcer from getting worse or leading to a dissection.
Imaging Surveillance
If the ulcer is stable and not causing symptoms, your doctor may recommend regular imaging to monitor it closely over time.
Minimally Invasive Endovascular Repair
If the ulcer is deep, growing or causing bleeding, your doctor may use a minimally invasive procedure called thoracic endovascular aortic repair. A stent graft is placed through a small incision in the groin to reinforce the weakened part of the aorta from the inside.
Open Surgery
In rare, high-risk cases, like when the ulcer has ruptured or is part of a complex dissection, open surgical repair can remove the damaged portion of the aorta and replace it with a graft.
Our Approach to Aortic Ulcer Treatment
At Inspira, we rely on a collaborative team to diagnose and treat aortic ulcers promptly and effectively. Our specialists in cardiology, vascular surgery, radiology, critical care, and more work together to create personalized treatment plans for each patient. From advanced imaging to minimally invasive repairs or surgery, we use the latest technology and techniques. Our comprehensive services support patients from early detection through precise care and ongoing vascular health management.
