Outcome After Conservative and Endovascular Treatment of Stanford Type B Aortic Intramural Hematomas – A Single-Center Retrospective Study

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

Abstract

OBJECTIVES: Aortic intramural hematoma (IMH) is a rare disease. Thus far, only limited data is available and the indications for conservative and endovascular treatment are not well defined. The aim of this study was to investigate clinical presentation, course, CT imaging features and outcome of patients with type B aortic IMHs.

METHODS: We included all patients with type B IMHs between 2012 and 2021 in this retrospective monocentric study. Clinical data, localization, thickness of IMHs and the presence of ulcer-like projections (ULPs) was evaluated before and after treatment.

RESULTS: Thirty five patients (20 females; 70.3 y ± 11 y) were identified. Almost all IMHs (n = 34) were spontaneous and symptomatic with back pain (n = 34). At the time of diagnosis, TEVAR was deemed indicated in 9 patients, 26 patients were treated primarily conservatively. During the follow-up, in another 16 patients TEVAR was deemed indicated. Endovascularly and conservatively treated patients both showed decrease in thickness after treatment. Patients without ULPs showed more often complete resolution of the IMH than patients with ULPs (endovascularly treated 90.9% (10/11) vs 71.4% (5/7); conservatively treated 71.4% (10/14) vs 33.3% (1/3); P = .207). Complications after TEVAR occurred in 32% and more frequently in patients treated primarily conservatively (37.5% vs 22.2%). No in-hospital mortality was observed during follow-up.

CONCLUSIONS: Prognosis of IMH seems favourable in both surgically as well as conservatively treated patients. However, it is essential to identify patients at high risk for complications under conservative treatment, who therefore should be treated by TEVAR. In our study, ULPs seem to be an adverse factor for remodeling.

Details

Original languageEnglish
Pages (from-to)477-485
Number of pages9
JournalVascular and Endovascular Surgery
Volume58
Issue number5
Early online date29 Dec 2023
Publication statusPublished - Jul 2024
Peer-reviewedYes

External IDs

PubMed 38157519
ORCID /0000-0001-5061-9643/work/152544697

Keywords

Keywords

  • acute aortic syndrome, aortic intramural hematoma, computed tomography angiography, endovascular aortic repair, ulcer-like projection, Blood Vessel Prosthesis Implantation/adverse effects, Aortic Intramural Hematoma, Aortic Dissection/diagnostic imaging, Humans, Endovascular Procedures/adverse effects, Middle Aged, Risk Factors, Conservative Treatment/adverse effects, Male, Treatment Outcome, Aortic Diseases/diagnostic imaging, Computed Tomography Angiography, Time Factors, Hematoma/therapy, Aged, 80 and over, Female, Retrospective Studies, Aged

Library keywords