Abstract
Background: Type B aortic intramural hematoma (IMH-B) is recognized as a subset of aortic dissection. The evolution of uncomplicated IMH-B is very difficult to predict. How and when to deal with this disease is unclear. The present study constructed two models to explore this problem. One is the morphology evolution model, which explored the risk factors and predictors for the IMH-B patients. Another is the predictive model confirmed the predictors and the time for invasive treatment of uncomplicated IMH-B patients. Objective: To explore the evolution predictors and detect the time for invasive treatment of uncomplicated IMH-B patients. Methods: Themorphology evolution model demonstrated that all 81 patients were diagnosis with CTA images. The initial and follow-up data were retrospectively studied. The evolution data were collection and measurement from initial and follow-up CTA images data. The predictive model showed that predictors of progression were detected with cox regression analysis. Results: All 81IMH-B patients were followed-up ranged from 1.2 to 36 months (median, 22 months). 26 patients accepted invasive treatment (24 underwent TEVAR and 2 underwent Surgery). 55 patients received medical treatment. Invasive treatment (IT) group overall events are 1/26 (3.8%); medical treatment (MT) group overall events are 33/55 (60.0%); IT group vs. MT group: p . Moreover, we found that most events related aorta occurred within 30 days. Multivariate Cox regression analysis MDAD (hazard ratio, 3.58; 95% CI, 1.25- 5.78; p - 7.84; p - 5.63; p Conclusions: MDAD > 45 mm, MDAHT > 10 mm, and IMH with PAU may be the important predictors for uncomplicated IMH-B patients. Most adverse aorta related events occurred within 30 days. It would be careful follow-up, closely observe for these patients within 30 days, and take necessary treatment strategies in time.
Highlights
IMH-B is characterized by aortic wall hematoma without intimal tear or direct flow communication between true and false
All patients were diagnosed as type B aortic Intramural hematoma (IMH-B) with computed tomography angiography (CTA), IMH-B is noted as a descending aortic dissection without intimal tear, but the intimal defects are detected with high-resolution computed tomography, so IMH-B may be a subset of aortic dissections with very limited flow in the false lumen
In 81 patients, 26 patients were treated with invasive treatment overall events 1, 26 (3.8%), And 55 patients were treated with medical treatment overall events 33, 55 (60.0%) p < 0.001, we found that most events related to aortia were occurrence in early 30 days
Summary
IMH-B is characterized by aortic wall hematoma without intimal tear or direct flow communication between true and false. The etiology of this disease is unclear. Our study followed up the characteristics and evolution of IMH-B patients, explored the evolution predictors and the invasive treatment time for uncomplicated IMH-B patients. One is the morphology evolution model, which explored the risk factors and predictors for the IMH-B patients. Another is the predictive model confirmed the predictors and the time for invasive treatment of uncomplicated IMH-B patients. Objective: To explore the evolution predictors and detect the time for invasive treatment of uncomplicated IMH-B patients. Conclusions: MDAD > 45 mm, MDAHT > 10 mm, and IMH with PAU may be the important predictors for uncomplicated
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