Focal Intimal Disruption Size at Multidetector CT and Disease                     Progression in Type B Aortic Intramural Hematoma

Ishizu, Kenichi; Kaji, Shuichiro; Nakashima, Masaki; Kitai, Takeshi; Kim, Kitae; Ehara, Natsuhiko; Kinoshita, Makoto; Furukawa, Yutaka

doi:10.1148/radiol.2021204385

Cited by 11 publications

(16 citation statements)

References 29 publications

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“…Of these, 17 studies were included in the present review, all observational and retrospective ( Figure 1 ). Two studies only reported on PAUs [ 11 , 14 ], two studies reported on PAUs and IMHs [ 5 , 10 ] and thirteen articles only concentrated on IMHs [ 12 , 13 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ].…”

Section: Resultsmentioning

confidence: 99%

“…ARM timing was specified in five studies [ 10 , 18 , 19 , 21 , 24 ], and it occurred in the acute phase in 17/433 cases (3.9%). The number of patients undergoing intervention was reported in 12 studies [ 10 , 12 , 13 , 16 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 25 ], with a rate of 21% during follow-up (241/1147 cases) ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…The outcome AAE was defined as composite of endovascular or surgical repair, aortic rupture, development of AD, progressive aortic enlargement and disease evolution, such as ULP (or FID) development [ 12 , 13 , 17 , 19 , 20 , 21 , 23 , 25 ]. The cumulative AAE rate based on seven studies was 32% (249/768 examined cases).…”

Section: Resultsmentioning

confidence: 99%

“…The cumulative AAE rate based on seven studies was 32% (249/768 examined cases). According to Ishizu et al [ 19 ], AAE onset was more frequent in patients with large FID at the time of diagnosis (15/28, 54%); meanwhile, according to Chen et al [ 17 ], acute adverse events only happened in the subgroup of patients with obstructive sleep apnea (OSA).…”

Section: Resultsmentioning

confidence: 99%

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Clinical and Imaging Predictors of Disease Progression in Type B Aortic Intramural Hematomas and Penetrating Aortic Ulcers: A Systematic Review

et al. 2022

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Background: This work aims to review recent literature on penetrating aortic ulcers (PAUs) and intramural hematomas (IMHs), in order to identify clinical and imaging factors connected to aortic-related adverse events (AAE). Methods: We performed a systematic review according to the Preferred Reporting Items for Systematic review and Metanalyses (PRISMA) guidelines. An electronic search was conducted on Medline and Embase databases. We included articles reporting on PAUs and/or IMHs localized in the descending thoracic and/or abdominal aorta and analyzing clinical and/or radiological markers of AAE. Results: Of 964 records identified through database searching, 17 were incorporated in the present review, including 193 and 1298 patients with type B PAUs and IMHs, respectively. The 30-days aortic-related mortality (ARM) was 4.3% and 3.9% for PAUs and IMHs. A total of 21% of patients with IMHs underwent intervention during the follow-up period, and 32% experienced an AAE. PAU markers of AAE were minimum depth (ranging from 9.5 to 15 mm) and diameter (≥12.5 mm). Maximum aortic diameter (MAD) cut-off values ranging from 38 to 44.75 mm were related to AAE for IMHs, together with ulcer-like projection (ULP) of the aortic wall. Conclusions: Despite data heterogeneity in the literature, this PAU- and IMH-focused review has highlighted the imaging and clinical markers of disease progression, thus identifying patients that could benefit from an early intervention in order to reduce the AAE rate.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Clinical and Imaging Predictors of Disease Progression in Type B Aortic Intramural Hematomas and Penetrating Aortic Ulcers: A Systematic Review

et al. 2022

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“…Our results mirror previously published studies focused on the natural history and outcomes associated with small asymptomatic PAUs, in which that similarly found these lesions to be indolent and associated with a low rate of growth or development of adverse events ( 8 , 15 – 17 ). While atherosclerosis likely plays some role in the development of such FIF lesions, other etiologies have been described, such as residua of prior IMH ( 18 , 19 ). While patients with IMH a documented history of IMH, dissection or acute aortic syndrome were excluded from this study, and there were no imaging findings of IMH in the CTAs analyzed, given the age and comorbidities observed in this cohort its plausible that other etiologies including sequala of a prior dissection or IMH may contribute to the formation of some FIF lesions.…”

Section: Discussionmentioning

confidence: 99%

Natural history and clinical significance of aortic focal intimal flaps

Maas

Bakel

Ahmed

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveFocal intimal flaps (FIF) are a variety of defects of the aorta that result in a short, flap-like projection into the lumen, and are often encountered in asymptomatic patients undergoing computed tomography angiography (CTA) surveillance for aortic aneurysm, but the natural history and clinical significance of such lesions has not yet been studied.MethodsWe retrospectively identified patients with an asymptomatic FIF and available imaging follow-up (>1 year). FIF was defined as flap-like intimal irregularity < 4 cm in length involving the thoracic aorta (TA), abdominal aorta (AA) or common iliac arteries (CIA). FIF characteristics included length and circumferential extent as well as the presence and size (width and depth) of associated penetrating aortic ulcers (PAUs). Patient characteristics, adverse events and history of surgical repair was determined by chart review. FIFs and associated PAUs were assessed for progression by comparing baseline and follow-up CTA studies.ResultsA total of 84 FIFs were identified in 77 patients. Average age was 69.2 ± 10.1 years, and 81% were male (81%). Common co-morbidities included: hypertension (78%), hyperlipidemia (68%), smoking (60%), coronary artery disease (41%), aortic aneurysm (34%), type II diabetes mellitus (27%) and prior cardiovascular surgery (25%). FIFs were most commonly located in the abdominal aorta (n = 50, 60%). Nearly all FIFs were associated with local atherosclerotic plaque (93%). Mean follow-up interval was 3.5 ± 2.6 years (259 cumulative follow-up years). Change in FIF length and local aortic diameter over follow-up were 0.7 ± 2.3 mm and 0.8 ± 1.1 mm, respectively. Nearly half (47%) of FIFs were associated with penetrating aortic ulcers (PAU) with baseline depth of 7.3 mm (IQR: 6.1–10.2) and change in depth of 0.5 ± 1.4 mm. Only 12% of FIFs and 0% of associated PAUs demonstrated growth (≥3 mm) at follow-up. No acute pathology developed in the location of FIFs and no aortic interventions were performed specifically to treat FIFs.ConclusionFocal intimal flaps identified in asymptomatic patients with aortic disease were co-localized with atherosclerotic plaque and PAUs, and demonstrated indolent behavior, not leading to significant growth or acute aortic events, supporting a conservative management approach.

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Role of Initial Focal Contrast Enhancement in Type B Intramural Hematoma

Spanos,

Kölbel

2024

Journal of the American College of Cardiology

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Focal Intimal Disruption Size at Multidetector CT and Disease Progression in Type B Aortic Intramural Hematoma

Cited by 11 publications

References 29 publications

Clinical and Imaging Predictors of Disease Progression in Type B Aortic Intramural Hematomas and Penetrating Aortic Ulcers: A Systematic Review

Clinical and Imaging Predictors of Disease Progression in Type B Aortic Intramural Hematomas and Penetrating Aortic Ulcers: A Systematic Review

Natural history and clinical significance of aortic focal intimal flaps

Role of Initial Focal Contrast Enhancement in Type B Intramural Hematoma

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