Acute Intramural Hematoma of the Descending Aorta Treated with Stent Graft Repair Is Associated with a Better Prognosis

Ye, Kaichuang; Qin, Jining; Yin, Ming; Jiang, Mier; Liu, Weimin; Lu, Xinwu

doi:10.1016/j.jvir.2017.06.034

Cited by 28 publications

(36 citation statements)

References 27 publications

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“…IMHB without obvious mal‐perfusion syndrome is always regarded as a benign disease because of the good outcome. In our study, the more aggressive therapy group had similar mortality as previous studies (2.5% vs 0%, Ye et al; 2.5% vs 0%, Bischoff et al). Li et al and Zhang et al also reported good outcomes of prophylactic TEVAR.…”

Section: Discussionsupporting

confidence: 89%

“…Bischoff et al reported that patients with larger ascending aorta diameters had a worse clinical outcome. Ye et al also suggested that patients with larger aortic diameters (>45 mm) and higher hematoma thicknesses (>10 mm) should be classified as “complicated” and receive more aggressive TEVAR to prevent the progression of hematoma …”

Section: Discussionmentioning

confidence: 99%

“…Currently, following the suggestion of type B aortic dissection management, the “watchful waiting strategy” is still the first choice, especially for patients with potential high surgery risks, and the mortality rate after the acute phase is between 4% and 19% . Advocators of the necessary TEVAR procedure for IMHB patients with disease progression and uncontrollable syndromes have reported that it could prevent further progression of IMHB and achieve a better prognosis than medical treatment alone . However, for patients with disease progression and uncontrollable syndromes who lack sufficient medical treatment, the fragile aortic wall will probably result in higher postoperative mortality, which is the major problem with the “watchful waiting strategy.” Therefore, other physicians have advocated a more aggressive treatment (prophylactic TEVAR during the acute phase) for IMHB patients with disease progression when the syndromes were still controllable, and better outcomes than those with the conventional “watchful waiting strategy” have been reported .…”

Section: Introductionmentioning

confidence: 99%

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The evolution of treatments for uncomplicated type B intramural hematoma patients

Jiang

Feng

et al. 2020

J Card Surg

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Objectives We aimed to investigate whether uncomplicated type B intramural hematoma (IMHB) patients with known evolution predictors could benefit from more aggressive therapy. Methods Retrospective analysis was performed in uncomplicated IMHB patients with evolution predictors between January 2001 and August 2018. Cox proportional hazard models were constructed to identify the specific factors associated with aorta‐related mortality. Results A total of 226 uncomplicated acute IMHB patients with evolution predictors were included. The conventional therapy group included 187 patients, and the other 39 patients received the more aggressive therapy. Aorta‐related mortality in the first year was higher in the conventional therapy group than in the more aggressive therapy group (15% vs 2.5%, P = .035), and more patients died after thoracic endovascular aortic repair (TEVAR) (13 of 27 patients, 48.1% vs 2.5%, P < .001). The more aggressive therapy group had a higher rate of hematoma resolution than the conventional therapy group (81.6% vs 62.2%, P = .024), a lower possibility of hematoma worsening (2.6% vs 17.0%, P = .021), and a lower reintervention rate (0% vs 11.9%, P = .028). Cox regression analysis revealed that a higher rate of focal intimal disruption (FID) development (hazard ratio [HR], 3.99; 95% confidence interval [CI], 1.16‐11.46, P = .010), and a higher C‐reactive protein (CRP) level (HR, 1.27; 95% CI, 1.16‐1.40, P < .001) were associated with increased aorta‐related mortality. Conclusions More aggressive therapy for uncomplicated IMHB patients with evolution predictors during the acute phase may result in better clinical outcomes. A higher rate of FID development and a higher CRP level are associated with increased aorta‐related mortality.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The evolution of treatments for uncomplicated type B intramural hematoma patients

Jiang

Feng

et al. 2020

J Card Surg

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“…3 Moreover, Bischoff et al also reported similar geometrical changes and worse clinical outcomes in unstable cases. Furthermore, Ye et al suggested that these unstable patients should be classified as “complicated” and treated with prophylactic TEVAR to prevent progression of the hematoma . Another potential explanation is that some patients in the no‐FID group had an FID before its final development to dissection or complete absorption but that the CTA examinations may have failed to capture this process.…”

Section: Discussionmentioning

confidence: 83%

“…Should these patients have undergone prophylactic TEVAR once an FID had been demonstrated and while the symptoms were controllable? Advocators of performing prophylactic TEVAR once an FID appears have reported better outcomes . In addition, TEVAR would change the geometry of the aorta and affect the survival of patients with a large diameter ascending aorta ( > 4 cm) who would be more likely to develop retrograde type A aortic dissection after TEVAR (42.4 ± 4.1 mm in the FID group).…”

Section: Discussionmentioning

confidence: 99%

Certain aortic geometries and hemodynamics are associated with FID development and impact the evolution of uncomplicated type B intramural hematoma during the acute phase

et al. 2019

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Objectives It is difficult to predict the evolution of uncomplicated type B intramural hematoma (IMHB) with a focal intimal disruption (FID) in the acute phase. The aims of this study were to investigate the predictors of FIDs and summarize the risk factors for the evolution of uncomplicated IMHB in the acute phase. Methods Eighty‐six patients with uncomplicated IMHB were included and were divided according to the development of an FID during the acute phase: the FID group (n = 32) and the no‐FID group (n = 54). Geometric measurements and computed fluid dynamic calculations were based on a computed tomography scan performed on admission. Multivariate logistic regression analysis was used to estimate the predictors of FID development. Results Thirty‐two (37%) patients developed an FID. Patients with an FID had higher C‐reactive protein levels (18.6 ± 2.3 vs 8.1 ± 0.2 mg/dL, P < 0.001) and white blood cell counts (10.3 ± 2.1 vs 7.5 ± 1.7 109/L, P < 0.001). The no‐FID group had lower occurrences of disease progression (15% vs 64%, P < 0.001) and aorta‐related mortality (6% vs 25%, P = 0.016). Multivariate logistic regression analysis indicated a significant risk for the occurrence of an FID with a larger maximum aortic diameter (OR, 1.35; 95% CI, 1.05‐1.73, P = 0.020), thicker hematoma (OR, 2.20; 95% CI, 1.40‐3.48, P = 0.001), and higher oscillatory shear index (per 0.01 unit, OR, 1.74; 95% CI, 1.21‐2.49, P = 0.003). The aorta‐related mortality during the acute phase was 25% (n = 8). Conclusions Certain aortic conditions, including ta larger aortic diameter, thicker hematoma and higher oscillatory shear stress, are associated with the FID development and result in worse clinical outcomes.

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A technical note and report of two patients with acute aortic syndrome who were treated with the new generation Ankura thoracic stent graft

Kratimenos

Antonopoulos

Tomais

et al. 2021

Clinical Case Reports

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Acute Intramural Hematoma of the Descending Aorta Treated with Stent Graft Repair Is Associated with a Better Prognosis

Cited by 28 publications

References 27 publications

The evolution of treatments for uncomplicated type B intramural hematoma patients

The evolution of treatments for uncomplicated type B intramural hematoma patients

Certain aortic geometries and hemodynamics are associated with FID development and impact the evolution of uncomplicated type B intramural hematoma during the acute phase

A technical note and report of two patients with acute aortic syndrome who were treated with the new generation Ankura thoracic stent graft

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