Thoracic Endovascular Aortic Repair for Retrograde Type A Aortic Intramural Hematoma.

Gen Li,Xia Xu,Jun Li,Sizheng Xiong

doi:10.3389/fcvm.2021.712524

Abstract

Objectives: To evaluate the effects of thoracic endovascular aortic repair (TEVAR) in descending aorta for retrograde type A aortic intramural hematoma (re-TAIMH).Methods: From January 2013 to September 2019, 65 consecutive patients diagnosed with re-TAIMH and treated by TEVAR were enrolled in this retrospective cohort study, of whom 44 patients presented with entry tear in descending aorta (Group A) and 21 with penetrating atherosclerotic ulcer (Group B). The clinical data, including baseline characteristics, adverse events, aortic remolding, and overall survival were reviewed.Results: The mean age of all the patients was 52.0 ± 8.3 years, and 54 (83.1%) patients were men. The mean maximal ascending aortic diameter (MAAD) was 43.1 ± 5.4 mm, and the mean maximal ascending aortic hematoma thickness (MAAHT) was 9.6 ± 4.7 mm. TEVAR was performed under general anesthesia in 53 (81.5%) patients, while 12 (18.5%) patients were treated under local anesthesia. There were two deaths during hospitalization (one with rupture and another with multiple organ dysfunction syndrome), and overall survival at 1, 4, and 7 years for all 65 patients was 93.8, 92.0, and 87.4%, respectively. The MAAD and MAATH decreased significantly after TEVAR (p < 0.05) in the two groups, so did the mean descending aortic diameter at the pulmonary bifurcation level. Type I endoleak, dialysis, progression to type A aortic dissection, and enlargement in MAAHT and MAAD were more common complications, which occurred in four, three, two, and two patients, respectively.Conclusion: Patients with retrograde TAIMH treated by TEVAR had a favorable prognosis including late survival and aortic remolding. However, some post-intervention complications were not negligible.

Highlights

Aortic intramural hematoma (IMH), first described by Krukenberg [1], constitutes acute aortic syndrome (AAS) with penetrating atherosclerotic ulcer (PAU) and aortic dissection (AD) [1, 2]
This study aims to evaluate the effects of thoracic endovascular aortic repair (TEVAR) for re-Type A aortic intramural hematoma (TAIMH) by analyzing the in-hospital and follow-up outcomes of 65 patients
TAIMH is defined as hemorrhage consisting of a circular or crescentic thickening around the ascending aorta, and there is no Abbreviations: IMH, aortic intramural hematoma; AAS, acute aortic syndrome; PAU, penetrating atherosclerotic ulcer; AD, aortic dissection; TAIMH, type A aortic intramural hematoma; ULP, ulcer-like projection; Re-TAIMH, retrograde type A aortic intramural hematoma; TEVAR, thoracic endovascular aortic repair; CTA, contrast-enhanced computed tomography angiogram; TL, true lumen; FL, false lumen; MAAD, maximal ascending aortic diameter; MAAHT, maximal ascending aortic hematoma thickness; DAD, descending aortic diameter; LSCA, left subclavian artery

Summary

Introduction

Aortic intramural hematoma (IMH), first described by Krukenberg [1], constitutes acute aortic syndrome (AAS) with penetrating atherosclerotic ulcer (PAU) and aortic dissection (AD) [1, 2]. The cause of IMH is currently recognized as rupture of vasa-vasorum of aorta wall or intimal fracture induced by the progress of the atherosclerotic plaque [4]. PAU in descending aorta can cause descending aortic hematoma, while some scholars propose that the TAIMH could be induced by PAU located in descending aorta [7,8,9]. The two rare and special entities, TAIMH with PAU or entry tear (intimal flap) in descending aorta, are named retrograde TAIMH (re-TAIMH) in current studies

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