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Objective Penetrating atherosclerotic ulcer generally occurs in elderly patients with systemic atherosclerosis, predominantly in the descending thoracic aorta, and it is uncommon in the infrarenal aorta. We reviewed our experience of endovascular treatment of penetrating aortic ulcer in the infrarenal aorta. Methods In the last 4years, out of 348 patients who underwent abdominal aortic procedures, a total of 13 patients (12 men and 1 woman) were found to have an abdominal penetrating aortic ulcer, corresponding to an incidence of 3.7%. Mean age was 73±7years. All patients had hypertension. Three lesions were discovered incidentally and 10 were symptomatic. All patients underwent endovascular treatment in the operating room. Follow-up included CT-A control at 1, 4 and 12months after the intervention, and yearly thereafter. Results Primary technical success was 100%. No postoperative death was observed. Mean operative time was 100±29min. Mean blood loss was 168±133ml. No patient required intensive care unit stay. We observed one major complication (transient ischemic attack). Mean hospital stay was 4±1days. During a mean follow-up period of 26months no endoleak, aneurysm evolution or stent graft failure was recognized in any patient. One patient died 24months after the intervention after a stroke. Conclusions In our experience, endovascular or repair of infrarenal aortic ulcer appears feasible, and midterm results satisfactory.

Diabetic foot is complex and difficult to treat. More aggressive treatment using peripheral distal by-pass frequently combined to minor amputations has greatly improved limb salvage in most patients. However, diabetes-related amputations are at high risk of non-healing or superinfection, thus requiring a second-step surgical revision treatment more frequently than in non-diabetic patients. Several advanced technologies have been developed to improve the treatment of diabetic foot wounds including Vacuum Assisted Therapy: we present 3 cases of diabetic patients treated with preliminary surgical peripheral revascularization, subsequent minor amputation in combination with Vacuum Assisted Therapy performed in a day-surgery regime.