Thoracic endovascular aortic repair of the aortic dissection with intimal tears in the descending aorta and retrograde intramural hematoma

Abstract

Objective To analyse the clinical features of the aortic dissection with intimal tears in the descending aorta and retrograde intramural hematoma (RIMH) , and to explore the clinical experience of thoracic endovascular aortic repair (TEVAR) for these diseases. Methods From January 2011 to May 2014, 36 patients were diagnosed with aortic dissection with intimal tears in the descending aorta and RIMH by CT angiography at the Department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of Guangzhou Command. The clinical data, including the imaging findings, preoperativetreatment, timing of surgery, and prognosis were retrospectively analyzed. Results All the 36 cases received treatment of hypertension and lowering of heart rate, followed by TEVAR to cover the entry tears, with RIMH being closely observed. TEVAR was performed within 2 weeks in 11 patients, among whom 2 developed retrograde dissection or new aortic arch dissection occurred in 2 cases; TEVAR was performed beyond 2 weeks in 25 patients, and retrograde dissection occurred in one case. Conclusion TEVAR for aortic dissection patients with intimal tears in the descending aorta and RIMH is feasible, and should be performed 2 weeks after onset. Key words: Thoracic aorta; Aortic dissection; Endovascular repair; Intramural hematoma