Aorta Related and All-cause Mortality in Patients with Aortic Intramural Haematoma

Schoenhoff, Florian; Zanchin, Christian; Czerny, Martin; Makaloski, Vladimir; Gahl, Brigitta; Carrel, Thierry; Schmidli, Jürg

doi:10.1016/j.ejvs.2017.07.001

Cited by 39 publications

(43 citation statements)

References 20 publications

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“…Schoenhoff et al also reported that there was no difference in mortality in patients who underwent TEVAR within and after the first 2 weeks (25% vs 29%) . Compared with Schoenhoff's study, our study showed an obviously higher mortality of TEVAR after 2 weeks (48% vs 29%) and lower mortality of TEVAR within 2 weeks (2.5% vs 25%) …”

Section: Discussioncontrasting

confidence: 59%

“…Schoenhoff and colleagues reported that 43% of type B IMH patients underwent TEVAR during the first 2 weeks after diagnosis because of the visualization of an entry tear and aneurysm development, and 19% patients received TEVAR after the acute phase and during the first year . Schoenhoff et al also reported that there was no difference in mortality in patients who underwent TEVAR within and after the first 2 weeks (25% vs 29%) . Compared with Schoenhoff's study, our study showed an obviously higher mortality of TEVAR after 2 weeks (48% vs 29%) and lower mortality of TEVAR within 2 weeks (2.5% vs 25%) …”

Section: Discussioncontrasting

confidence: 57%

“…Aortic dissection requires stent grafts oversized by less than 5% to 10%, and thoracic aorta aneurysms require stent grafts oversized by 10% to 15% . We utilized a smaller oversized stent graft (8.3 ± 0.8% vs 8.5 ± 0.8%, P = .208; Table ) than the report of Schoenhoff et al (10‐15%) . In addition, we had a lower mortality due to TEVAR within 2 weeks (2.5% vs 25%), while Schoenhoff et al reported a lower mortality due to TEVAR after 2 weeks (29% vs 48%) .…”

Section: Discussionmentioning

confidence: 84%

“…However, 27 patients (14%) in the conventional therapy group required TEVAR treatment in the first year after the acute phase, and the mortality of these patients was higher than of those who received prophylactic TEVAR during the acute phase (48.1% vs 2.5%, P < .001). Schoenhoff and colleagues reported that 43% of type B IMH patients underwent TEVAR during the first 2 weeks after diagnosis because of the visualization of an entry tear and aneurysm development, and 19% patients received TEVAR after the acute phase and during the first year . Schoenhoff et al also reported that there was no difference in mortality in patients who underwent TEVAR within and after the first 2 weeks (25% vs 29%) .…”

Section: Discussionmentioning

confidence: 99%

“…Cox regression analysis also revealed that these two predictors were associated with increased aorta‐related mortality (Table ). Schoenhoff's study did not mention the incidence rate of evolution predictors . Moral et al reported that FID development (10%) in the acute phase was associated with 91% of aorta‐related adverse events, and mortality was up to 36%.…”

Section: Discussionmentioning

confidence: 99%

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The evolution of treatments for uncomplicated type B intramural hematoma patients

Jiang

Feng

et al. 2020

J Card Surg

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Objectives We aimed to investigate whether uncomplicated type B intramural hematoma (IMHB) patients with known evolution predictors could benefit from more aggressive therapy. Methods Retrospective analysis was performed in uncomplicated IMHB patients with evolution predictors between January 2001 and August 2018. Cox proportional hazard models were constructed to identify the specific factors associated with aorta‐related mortality. Results A total of 226 uncomplicated acute IMHB patients with evolution predictors were included. The conventional therapy group included 187 patients, and the other 39 patients received the more aggressive therapy. Aorta‐related mortality in the first year was higher in the conventional therapy group than in the more aggressive therapy group (15% vs 2.5%, P = .035), and more patients died after thoracic endovascular aortic repair (TEVAR) (13 of 27 patients, 48.1% vs 2.5%, P < .001). The more aggressive therapy group had a higher rate of hematoma resolution than the conventional therapy group (81.6% vs 62.2%, P = .024), a lower possibility of hematoma worsening (2.6% vs 17.0%, P = .021), and a lower reintervention rate (0% vs 11.9%, P = .028). Cox regression analysis revealed that a higher rate of focal intimal disruption (FID) development (hazard ratio [HR], 3.99; 95% confidence interval [CI], 1.16‐11.46, P = .010), and a higher C‐reactive protein (CRP) level (HR, 1.27; 95% CI, 1.16‐1.40, P < .001) were associated with increased aorta‐related mortality. Conclusions More aggressive therapy for uncomplicated IMHB patients with evolution predictors during the acute phase may result in better clinical outcomes. A higher rate of FID development and a higher CRP level are associated with increased aorta‐related mortality.

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Section: Discussioncontrasting

confidence: 59%

Section: Discussioncontrasting

confidence: 57%