Outcomes of medically treated patients with aortic intramural hematoma

Song, Jae Kwan; Kim, Hyun Sook; Song, Jong Min; Kang, Duk Hyun; Ha, Jong Won; Rim, Se Joong; Chung, Namsik; Kim, Kee Sik; Park, Seung Woo; Kim, Yong-Jin; Sohn, Dae Won

doi:10.1016/s0002-9343(02)01171-3

Cited by 105 publications

(57 citation statements)

References 24 publications

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“…The relatively low mortality rate reported in Asian IMH patients may be due to a genetic factor or the fact that more limited IMHs were diagnosed and included in their series, because the percentage of IMH in Asia in suspected AD is much higher than in our study. 8,13,15,18 Hypothetically, it is possible that those receiving surgery may represent patients in whom initial watchful waiting was complicated by the development of classic AD with complications, although we do not have data to support this. Because the mortality of acute IMH involving the ascending aorta remains high ( Figure 1) and nearly 16% of patients who had IMH on an initial imaging study had developed frank AD by the second imaging test (Figure 2), the IRAD data continue to favor consideration for timely surgical approach to such patients.…”

Section: Discussionmentioning

confidence: 96%

Acute Intramural Hematoma of the Aorta

Evangelista¹,

Mukherjee²,

Mehta³

et al. 2005

Circulation

444

183

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Background-The definition, prevalence, outcomes, and appropriate treatment strategies for acute intramural hematoma (IMH) continue to be debated. Methods and Results-We studied 1010 patients with acute aortic syndromes who were enrolled in the International Registry of Aortic Dissection (IRAD) to delineate the prevalence, presentation, management, and outcomes of acute IMH by comparing these patients with those with classic aortic dissection (AD). Fifty-eight (5.7%) patients had IMH, and this cohort tended to be older (68.7 versus 61.7 years; PϽ0.001) and more likely to have distal aortic involvement (60.3% versus 35.3%; PϽ0.001) compared with 952 patients with AD. Patients with IMH described more severe initial pain than did those with AD but were less likely to have ischemic leg pain, pulse deficits, or aortic valve insufficiency; moreover, they required a longer time to diagnosis and more diagnostic tests. Overall mortality of IMH was similar to that of classic AD (20.7% versus 23.9%; Pϭ0.57), as was mortality in patients with IMH of the descending aorta (8.3% versus 13.1%; Pϭ0.60) and the ascending aorta (39.1% versus 29.9%; Pϭ0.34) compared with AD. IMH limited to the aortic arch was seen in 7 patients, with no deaths, despite medical therapy in only 6 of the 7 individuals. Among the 51 patients whose initial diagnostic study showed IMH only, 8 (16%) progressed to AD on a serial imaging study. Conclusions-The IRAD data demonstrate a 5.7% prevalence of IMH in patients with acute aortic syndromes. Like classic AD, IMH is a highly lethal condition when it involves the ascending aorta and surgical therapy should be considered, but this condition is less critical when limited to the arch or descending aorta. Fully 16% of patients have evidence of evolution to dissection on serial imaging.

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Section: Discussionmentioning

confidence: 96%

Acute Intramural Hematoma of the Aorta

Evangelista¹,

Mukherjee²,

Mehta³

et al. 2005

Circulation

444

183

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“…Although the general consensus for the treatment of acute type A intramural hematoma is similar as in acute type A AD, 13 a small number of carefully conducted studies have argued in favor of initial medical management in selected patients with timely surgical intervention. [14][15][16] The inciting mechanisms or clinical features in acute retro-A AD and acute type A intramural hematoma are dissimilar, but the similarities in the features and clinical behavior of the thrombosed FL suggest that a comparable strategy for the treatment of acute type A intramural hematoma may be suitable for selected patients with acute retro-A AD as shown in our series and by Kaji et al 1 In the present series, 16 patients were deemed suitable for initial medical management, of which 3 had crossed over to surgery or thoracic endovascular aortic repair during their hospitalization. There were no early deaths among these patients, and the remaining 13 patients were uneventfully discharged.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Acute Retrograde Type A Aortic Dissection With an Entry Tear in Descending Aorta

et al. 2014

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Background-Optimal management strategy of acute aortic dissection (AD) with retrograde extension from entry tear in the descending aorta into the ascending aorta remains undetermined. Methods and Results-Of the 538 patients who were diagnosed as having acute AD from 1999 through 2011, 49 patients (37 men; 52.5±13.1 years) were identified as having entry tear in the descending aorta with retrograde extension of AD into the ascending aorta. Sixteen patients who were clinically stable with thrombosed false lumen in the ascending aorta were treated medically (MED group), whereas 33 patients underwent aortic replacement (SURG group) on an intentionto-treat basis. In the MED group, 1 patient was converted to urgent aortic surgery and 2 patients underwent endovascular stent grafting in the descending aorta during the initial hospitalization. The early (30-day or in-hospital) mortality rates were 0% and 9.1% in the MED and SURG group, respectively (P=0.54).

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“…2,3,7,8 However, the evolution of type A IMH appears to be more benign than that of AD and studies from Asian countries reported low mortality rates in medically treated proximal IMH. 9 -13 Song et al 13 reported that 67% of medically treated type A IMH patients showed disappearance of hematoma. In …”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Medical Therapy and Timely Operation in Initially Diagnosed Type A Aortic Intramural Hematoma

et al. 2009

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Background-The management of aortic intramural hematoma (IMH) involving the ascending aorta (type A) has not been well-established. The purpose of this study was to clarify the long-term clinical outcomes of patients with type A IMH who were treated with medical therapy and timely operation. Methods and Results-Clinical data including operative mortality, IMH-related events, and long-term survival were retrospectively reviewed in 66 patients with type A IMH, who were admitted to our institution from 1986 to 2006. Emergent surgical repair was performed in 16 (24%) patients because of severe complications, whereas 50 patients were treated with initial medical therapy. In medically treated patients, 15 (30%) patients who demonstrated progression to classic dissection or increase in hematoma size within 30 days underwent surgical repair except for 2 patients who refused surgery. The 30-day mortality rate was 6% with emergent surgery and 4% with supportive medial therapy. There were 7 late deaths and the actuarial survival rates of all patients were 96Ϯ3%, 94Ϯ3%, and 89Ϯ5% at 1, 5, and 10 years, respectively. In medically treated patients, maximum aortic diameter was the only predictor of early and late progression of ascending IMH (hazard ratio, 4.43; 95% CI, 2.04 -9.64; PϽ0.001). Aortic diameter Ն50 mm predicted progression of ascending IMH with the positive and negative value of 83% and 84%, respectively. Conclusions-Combination

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Outcomes of medically treated patients with aortic intramural hematoma

Cited by 105 publications

References 24 publications

Acute Intramural Hematoma of the Aorta

Acute Intramural Hematoma of the Aorta

Outcomes of Acute Retrograde Type A Aortic Dissection With an Entry Tear in Descending Aorta

Clinical Outcomes of Medical Therapy and Timely Operation in Initially Diagnosed Type A Aortic Intramural Hematoma

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