Clinical studyEndovascular Stent-graft Management of Aortic Intramural Hematomas
Section snippets
Materials and Methods
From August 2000 to October 2006, 69 patients were admitted to our institution for IMH. The Stanford classification of aortic dissection was used to categorize IMH according to the location of the disease. There were 43 type A and 26 type B IMHs. Of these 69 patients, 31 underwent surgical management (type A, n = 30; type B, n = 1) and 23 underwent medical management (type A, n = 9; type B, n = 14). The remaining 15 patients (type A IMH, n = 4; type B IMH, n = 11) underwent endovascular
Indications for Stent-graft Treatment
The main goal of stent-graft treatment in these cases is to cover the intimal tear to prevent progression of the hematoma within the aortic wall (and thereby to prevent an evolution to pericardial rupture or aortic dissection) or evolution of the intimal lesion to aneurysm formation. In cases of IMH without detectable intimal tear, stent-graft management is not indicated because there is no target lesion and covering the thickened wall will not improve it. All the patients included in this
Discussion
Intramural hematoma of the thoracic aorta is a cardiovascular emergency that is responsible for an overall hospital mortality rate of 16%–21% (13, 16, 17) and requires prompt diagnosis and aggressive management. However, a consensus regarding optimal management strategies for this disease has not yet been established (2, 18).
Mortality rates with medical treatment of type A IMH are high, ranging from 36% to 75% (16, 17, 19). In this regard, the standard treatment during the past decade has been
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Cited by (37)
Outcomes of intramural hematoma involving the ascending aorta and extending into the descending thoracic aorta
2022, Journal of Vascular SurgeryIntimal disruption in type B aortic intramural hematoma. Does size matter? A systematic review and meta-analysis
2018, International Journal of CardiologyAcute Intramural Hematoma of the Descending Aorta Treated with Stent Graft Repair Is Associated with a Better Prognosis
2017, Journal of Vascular and Interventional RadiologyTreatment indications for and outcome of endovascular repair of type B intramural aortic hematoma
2016, Journal of Vascular SurgeryCitation Excerpt :To minimize the risk of new lacerations, stent graft oversizing should not exceed 10% and balloon dilation of landing zones should not be performed. Some authors reported the risk of new intimal lesions or pseudoaneurysm formation due to endograft landing in IMH-affected zones.35,36 Therefore, Evangelista et al recently recommended that stent grafts should be anchored at least 15 mm within the intact aortic wall.5
Midterm Results of Type B Intramural Hematoma Endovascular Treatment
2015, Annals of Vascular SurgeryCitation Excerpt :Some authors suggest endovascular management as an alternative to the conventional approach to treat complicated IMH B, particularly when associated with ULPs. ULP seems to be an ideal target for endovascular treatment.13,16–19 The purpose of this study is to report our IMH B management experience, specifically with endovascular stent grafts.
None of the authors have identified a conflict of interest.