Intramural hematoma of the thoracic aorta: A single-institution, 12-year experience

Abdu, R.; Long, Graham W.; Baker, Dawn; Boudiab, Elizabeth; Callahan, Rose E.; Studzinski, Diane; Brown, O. William

doi:10.1016/j.jvs.2021.12.077

Cited by 5 publications

(4 citation statements)

References 25 publications

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“…The current mainstream view for type B IMH is that conservative treatment is the mainstay of the disease ( 11 ). In fact, some patients will eventually develop into dissection, aneurysm or even rupture during the follow-up period ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes of Stanford type B aortic intramural hematoma: A single centre experience

Zhang

et al. 2023

Front. Surg.

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ObjectiveTo compare the clinical characteristics of Stanford type B aortic intramural hematoma (IMH) and Stanford type B aortic dissection (AD), and to identify the differences between thoracic endovascular aortic repair (TEVAR) and medical management (MM) in the Stanford type B IMH patients.MethodsA retrospective observational study was conducted in patients treated between January 2015 and December 2016. The clinical characteristics and CT images of patients with type B IMH and type B AD were compared, and the clinical characteristics and CT images of patients in the type B IMH group who were treated with TEVAR and MM were compared.ResultsA total of 176 patients were included in this study, including 62 patients of type B IMH and 114 patients of type B AD. Five patients died in the IMH group and three in the AD group. The proximal hematoma or entry tear in both groups was mainly located in the descending aorta, and the proportion of the iliac artery involved in the AD group was significantly higher than that in the IMH group (31.6% vs. 8.1% P < 0.05). There were 50 MM patients and 12 TEVAR patients in the IMH group. No death occurred in the TEVAR group, while five patients in the MM group died. Seven patients in the MM group had disease progression vs. 12 in the TEVAR group (P < 0.05). The patients in the TEVAR group had more intima lesions than those in the MM group (83.3% vs. 30.0%, P < 0.05). TEVAR group involved more iliac artery hematoma than MM group (33.3% vs. 2.0%, P < 0.05). The maximum thickness of hematoma in TEVAR group was 14.9 ± 3.4 mm, which was significantly larger than that of MM group (10.2 ± 2.8 mm) (P < 0.05).ConclusionIn the diagnosis of IMH, patients' symptoms and high-risk signs of CTA should be paid attention to. TEVAR therapy should be actively considered on the basis of effective medical management when there are intima lesions (ULP/PAU), increased aortic diameter and hematoma thickness, extensive hematoma involvement, and pleural effusion.

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes of Stanford type B aortic intramural hematoma: A single centre experience

Zhang

et al. 2023

Front. Surg.

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“…However, the risk of rupture remains quite high, between 5% and 25% [3,6,7]. Regarding aneurysm formation, 20–35% of medically treated patients with TAIMH experience resolution during follow-up, without any further intervention [8–10]. The overall rate of aortic aneurysm formation is estimated at 50% during the extended follow-up [8,9 ▪ ].…”

Section: Natural Coursementioning

confidence: 99%

“…Regarding aneurysm formation, 20–35% of medically treated patients with TAIMH experience resolution during follow-up, without any further intervention [8–10]. The overall rate of aortic aneurysm formation is estimated at 50% during the extended follow-up [8,9 ▪ ]. Progression of IMH has been associated to initial aortic diameter and IMH thickness, presence of concomitant PAU or detectable intimal tear at diagnostic imaging [2,4 ▪ ,9 ▪ ].…”

Section: Natural Coursementioning

confidence: 99%

“…The management of TAIMH remains an issue of controversy, as Western recommendations support the immediate surgical management whereas some other recent studies and Eastern countries’ guidelines support TAIMH's conservative management, except if hemodynamic instability or organ malperfusion is present [2,4 ▪ ,8,9 ▪ ,19,20]. Despite the similarities in the underlying pathologic mechanisms with the typical dissection, urgent surgical management is not always indicated while risk stratification may constitute the optimal care [1,2,5 ▪ ].…”

Section: Indications and Risk Stratificationmentioning

confidence: 99%

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Ascending aortic intramural hematoma: current concepts

Nana

Kouvelos

Σπανός

2022

Current Opinion in Cardiology

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Purpose of reviewType A intramural hematoma (TAIMH) is an acute aortic disease characterized by the presence of hematoma in the aortic media and involving the ascending aorta. Open repair seems to be the first treatment approach, although recent evidence highlights that the best management of TAIMH is controversial. This review will focus on the current concept for TAIMH management and factors affecting the decision making.Recent findingsRecent studies have evaluated the role of open and endovascular repair, as well as conservative management in patients with TAIMH. More specific imaging findings seem to affect decision making for urgent repair.SummaryDespite TAIMH's acute nature, conservative management seems to represent a valid option for urgent approach, presenting similar mortality to open and endovascular repair. Comparative data are limited, however, in experienced centers, any approach may be applied with encouraging results. Endovascular management, which is mainly applied to manage retrograde TAIMH, is related to lower mortality and morbidity compared to open repair in this group of patients while aortic remodeling seems beneficial with this approach. Imaging findings, as ulcer-like lesions, hematoma thickness, concomitant dissection and aortic diameter, related to higher complication rate, set the indication for interventional management. Further research, including prospective data and registries, and ideally, randomized data may further clarify the best approach and factors indicating urgent repair.

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Commentary: A different animal but the same beast

Orozco-Sevilla

Coselli

2023

The Journal of Thoracic and Cardiovascular Surgery

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Intramural hematoma of the thoracic aorta: A single-institution, 12-year experience

Cited by 5 publications

References 25 publications

Clinical characteristics and outcomes of Stanford type B aortic intramural hematoma: A single centre experience

Clinical characteristics and outcomes of Stanford type B aortic intramural hematoma: A single centre experience

Ascending aortic intramural hematoma: current concepts

Commentary: A different animal but the same beast

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