ICVTS on-line discussion A

doi:10.1510/icvts.2006.136507A eComment: The authors stated that EVAR have no clinical relevance and have no effect on early outcome and on mid-term follow-up w1x. At this point, it could be interesting to introduce the condition named penetrating atherosclerotic ulcer wPAUx. In the last 50 months at my institution, 38 patients have undergone EVAR for AAA. A total of 3 patients were found to have an abdominal PAU. In every patient, PAU was diagnosed at computed tomography angiography wCT-Ax. Because they were treated electively, it was possible to obtain a histological diagnosis to support the CT diagnosis of PAU. On the basis of histological proofs, the diagnosis of PAU was not assumed but confirmed. PAU is the subject of considerable controversy with respect to definition as well as natural history. In our series, all three patients had distal ischemia caused by embolism, one of them with recurrent embolism that required amputation. The treatment of PAU remains controversial too. Open surgical repai