Therapeutic management of acute type A aortic intramural hematoma

Jue Yang,Changjiang Yu,Zerui Chen,Xin Li,Fei Xiao,Juntao Kuang,Tucheng Sun,Miaoxian Fang,Ruixin Fan

doi:10.1186/s12872-021-02104-4

Abstract

ObjectivesThe proper therapeutic management for acute type A aortic intramural hematoma (IMH) is still controversial. The purpose of this study was to compare the outcomes following emergency surgery or conservative treatment for patients with this disease.MethodsFrom January 2015 to December 2018, 124 consecutive patients were diagnosed with an acute type A aortic IMH and were included in this study. According to our surgical indications, they were divided into two groups: an operation group (OG) and a conservative treatment group (CG).ResultsOf 124 patients, 83 (66.9%) patients accepted emergency surgery and 41 (33.1%) patients accepted strict conservative treatment. There were no differences between these two groups in early mortality and complications. However, the late mortality of patients in the CG was significantly higher than for patients in the OG. A maximum aortic diameter in the ascending aorta and aortic arch ≥ 45 mm and maximum thickness of IMH in the same section ≥ 8 mm were risk factors for IMH related death in patients undergoing conservative treatment.ConclusionsThe mortality associated with emergency surgery for patients with acute type A aortic IMH was satisfactory. In clinical centers with well-established surgical techniques and postoperative management, emergency surgical treatment may provide a better outcome than medical treatment for patients with acute type A aortic IMH.

Highlights

Acute aortic intramural hematoma (IMH) is an entity within the spectrum of acute aortic syndrome (AAS), in which a hematoma develops in the media of the aortic wall in the absence of a false lumen and intimal tear [1]
We retrospectively reviewed our experience in the treatment of acute type A IMH and compared the outcomes for emergency or urgent surgery with conservative treatment for patients with this disease
Aortic IMH was defined as the presence of a circular or crescent shaped thickening of the aortic wall (≥ 5 mm) in the absence of detectable blood flow inside(a high attenuation area not enhanced after contrast medium administration) on multidetector computed tomography(MDCT), and accompanied by a clinical presentation compatible with acute aortic syndrome

Summary

Introduction

Acute aortic intramural hematoma (IMH) is an entity within the spectrum of acute aortic syndrome (AAS), in which a hematoma develops in the media of the aortic wall in the absence of a false lumen and intimal tear [1]. The natural history of acute aortic IMH is highly variable, The proper therapeutic management for acute aortic IMH is still controversial, especially for type A aortic IMH. In Western countries, the management of acute type A aortic IMH is emergency or urgent surgery. In Japan and Korea, there has been a growing trend towards conservative treatment without surgery for acute type A aortic IMH [2,3,4,5,6,7]. We retrospectively reviewed our experience in the treatment of acute type A IMH and compared the outcomes for emergency or urgent surgery with conservative treatment for patients with this disease

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