Journal of Vascular and Interventional Radiology
Clinical StudyAcute Intramural Hematoma of the Descending Aorta Treated with Stent Graft Repair Is Associated with a Better Prognosis
Section snippets
Patient Characteristics
The study protocol was reviewed and approved by the local medical ethics committee and institutional review board. This retrospective study comprised 65 patients with acute complicated or uncomplicated IMHB initially treated with TEVAR (TEVAR group, n = 34 patients) or OMT (OMT group, n = 31 patients) in a single institution between January 2006 and December 2015. Patients’ records were reviewed for demographic characteristics, concomitant diseases, morphologic nature of the aortic lesion,
Procedural Information
The procedural details of TEVAR are presented in Table 2. Technically successful TEVAR was performed in all patients with no procedure-related deaths (Fig E1a–f [available online at www.jvir.org]). There were 7 adjunctive procedures performed in 6 patients. One patient underwent arch debranching (left common carotid–to–left subclavian artery bypass), 2 patients underwent laser fenestration for the left subclavian artery, 1 patient underwent laser fenestration for both the left common carotid
Discussion
The main findings of this study were as follows: (a) Patients with IMHB have diverse clinical features but a much better long-term prognosis when treated with stent graft versus nonsurgical medical therapy. (b) Uncomplicated IMHB can progress to complicated IMHB, which can be a lethal condition. Therefore, the current indications for TEVAR for IMHB may require further modification. (c) Among patients treated with OMT, almost all aortic-related adverse events occurred in the first 6 months of
Acknowledgments
This study was financially supported by the National Natural Science Foundation of China (81500371) and the Science and Technology Committee of Shanghai (SHDC12015112, 15411967300, and 134119a2100). K.Y. gratefully acknowledges the support of Shanghai JiaoTong University K. C. Wong Medical Fellowship fund.
References (27)
- et al.
2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine
J Am Coll Cardiol
(2010) - et al.
The differences and similarities between intramural hematoma of the descending aorta and acute type B dissection
J Vasc Surg
(2013) - et al.
Treatment indications for and outcome of endovascular repair of type B intramural aortic hematoma
J Vasc Surg
(2016) - et al.
Endovascular stent-graft management of aortic intramural hematomas
J Vasc Interv Radiol
(2009) - et al.
Midterm results of type B intramural hematoma endovascular treatment
Ann Vasc Surg
(2015) - et al.
Type B intramural hematoma of the aorta: evolution and prognostic value of intimal erosion
J Vasc Interv Radiol
(2011) - et al.
Indication, timing and results of endovascular treatment of type B dissection
Eur J Vasc Endovasc Surg
(2009) - et al.
Computed tomography evaluation of aortic remodeling after endovascular treatment for complicated ulcer-like projection in patients with type B aortic intramural hematoma
J Vasc Surg
(2014) - et al.
Long-term outcome of type B aortic intramural hematoma: comparison with classic aortic dissection treated by the same therapeutic strategy
Ann Thorac Surg
(2004) - et al.
Repair of retrograde ascending dissection after descending grafting
J Thorac Cardiovasc Surg
(2014)
Intramural hematoma of the thoracic aorta
Eur J Cardiothorac Surg
Acute intramural hematoma of the aorta: a mystery in evolution
Circulation
Long-term prognosis of patients with type A aortic intramural hematoma
Circulation
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2022, Journal of Vascular SurgeryCitation Excerpt :Endovascular lining of the aorta would promote aortic remodeling by sealing off potential microtears in the intima in “idiopathic” IMH and the ulcer in patients with IMH and concomitant PAU. Aortic endograft stenting has been reported by several institutions to expedite aortic healing, improve symptomatology, and improve aortic-related survival.9-11,37 All patients seem to have experienced improved aortic remodeling regardless of the presence of PAU or not.
Outcomes of intramural hematoma involving the ascending aorta and extending into the descending thoracic aorta
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None of the authors have identified a conflict of interest.
Figures E1 and E2 are available online at www.jvir.org.