The characteristic and treatment of intramural hematoma in elderly patients without trauma

Abstract

Objective To analyze the characteristics and treatment of aortic intramural hematoma(IMH) in non-traumatic elderly patients, and to provide clinical reference for the diagnosis and treatment of this disease. Methods A retrospective analysis of clinical data of 36 elderly patients without trauma during the period from March 2013 to May 2017 in our hospital , to clarify the characteristics of pathogenesis and imaging feature, and to evaluate treatment options. Results 36 patients were followed up and the outcomes of them were satisfactory. Of which 17 asymptomatic patients were given conservative treatment. 19 cases of emergency patients, 7 patients received the emergency operation, 9 patients were given interventional treatment after initial conservative medical treatment, 3 patients received drug treatment, of which 1 patient was conservatively successful, and 2 patients progressed. During follow-up, the imaging data of most of the patients were obtained. The aortic enhanced CT indicated that the hematoma disappeared or decreased markedly, and the asymptomatic patients were in stable condition, and the dilatation of aorta was not obvious in patients who have access to imaging examination. Conclusion Elderly patients with IMH are more common in men, especially Stanford B type. IMH in asymptomatic elderly patients with multiple penetrating aortic ulcer(PAU), but the range of hematoma is limited, no significant progress. And this type of patients can be considered only for conservative treatment. On the contrary, IMH of symptomatic elderly patients usually involve a wide range of aorta, and most of them were caused by single small ulcer. Although the patients have been treated with conservative medicine, the disease is still progress and endovascular treatment repair of aorta can be considered. Key words: Intramural hematoma; Elderly patients; Penetrating aortic ulcer; Treatmen