Long-Term Follow-Up of Aortic Intramural Hematoma

Abstract

Background-Aortic intramural hematoma (IMH) evolves very dynamically in the short-term to regression, dissection, or aortic rupture. The aim of the present study was to assess the long-term clinical and morphological evolution of medically treated IMH. Methods and Results-Fifty of 68 consecutive patients with aortic IMH monitored clinically and by imaging techniques at 3, 6, and 12 months and annually thereafter were prospectively studied. Mean follow-up was 45Ϯ31 months. In the first 6 months, total IMH regression was observed in 14 and progression to aortic dissection in 18 patients; in 14 of these, the dissection was localized, and 12 later developed pseudoaneurysm. At the end of follow-up, the IMH had regressed completely without dilatation in 17 patients (34%), progressed to classical dissection in 6 (12%), evolved to fusiform aneurysm in 11 (22%), evolved to saccular aneurysm in 4 (8%), and evolved to pseudoaneurysm in 12 (24%). Evolution to dissection was related to echolucency (PϽ0.02) and to longitudinal extension of IMH (PϽ0.01). Multivariate analysis showed an independent association between regression and smaller maximum aortic diameter and between aneurysm formation and atherosclerotic ulcerated plaque and absence of echolucent areas in IMH. Conclusions-The most frequent long-term evolution of IMH is to aortic aneurysm or pseudoaneurysm. Complete regression without changes in aorta size is observed in one third of cases, and progression to classical dissection is less common. A normal aortic diameter in the acute phase is the best predictor of IMH regression without complications, and absence of echolucent areas and atherosclerotic ulcerated plaque are associated with evolution to aortic aneurysm.

The role of multidetector-row CT in the diagnosis, classification and management of acute aortic syndrome

“…[50][51][52][53][54][55] The most important of these are the involvement of the ascending aorta and a maximum aortic diameter $5.0 cm. [52][53][54] In addition to these features, the presence of large, haemorrhagic or enlarging pleural or pericardial effusions is suggestive for disease progression. 2,52 It is important to differentiate ulcer-like projections from intramural blood pools in patients with IMH.…”

Is the Optimal Management of Acute Type A Aortic Intramural Hematoma Evolving?

“…However, 2 significant differences between IMH and aortic dissection appear to be well defined. First, IMH might regress spontaneously with time 4,5,7,9 (Figure 2). Second, fewer severe cardiovascular complications, valvular aortic regurgitation, and visceral or peripheral ischemia are present.…”

“…The marked relationship between IMH and atherosclerotic disease explains the older age of these patients compared with those with aortic dissection, the higher incidence of arterial hypertension, and the tendency for descending aorta involvement (50% to 60%). [1][2][3][4][5] …”

Acute Intramural Hematoma of the Aorta

“…A normal aortic diameter in the acute phase is the best predictor of IMH regression without complications, and the absence of echolucent areas and atherosclerotic, ulcerated plaque are associated with evolution to aortic aneurysm. 23 Motoyoshi et al 24 studied 36 patients with IMH and suggested that urgent surgical repair was not necessary for all type A IMH patients to achieve favorable surgical outcome with careful imaging follow-up. Moizumi et al 25 reported long-term outcomes for 95 cases of type A and type B IMH, showed that adverse events occur equally in both types of IMH of the aorta, and recommended close follow-up for at least 5 years because most IMHs of aorta-related events occur during this period.…”