Analysis of predictive factors for progression of type B aortic intramural hematoma with computed tomography

Sueyoshi, Eijun; Imada, Tatsuya; Sakamoto, Ichiro; Matsuoka, Yoshikazu; Hayashi, Kuniaki

doi:10.1067/mva.2002.123683

Cited by 99 publications

(58 citation statements)

References 15 publications

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“…6,7,12,14,15 These results can be explained by the La Place Law. 4,6 It states that the perpendicular stress on a cylinder is directly proportional to the pressure exerted by the fluid contents and its radius and is inversely proportional to wall thickness.…”

Section: Discussionmentioning

confidence: 68%

Growth Rate of Aortic Diameter in Patients With Type B Aortic Dissection During the Chronic Phase

Sueyoshi

Sakamoto²,

Hayashi³

et al. 2004

Circulation

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166

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Background-The purpose of this study was to evaluate the growth rate of type B double-barrel aortic dissection with computed tomography (CT) and the factors influencing its enlargement. Methods and Results-Sixty-two patients were entered into this study, and regular follow-up CT studies (mean; 49.1 months) were performed. The affected aortas and iliac arteries were divided into 5 segments (aortic arch, descending thoracic, suprarenal abdominal, infrarenal abdominal aorta, and iliac artery). Fifty-two of 62 patients (83.9%) had 1 or more segments increased in size during follow-up period. In a total of 177 segments, the presence or absence of blood flow in the false lumen and aortic diameter were evaluated on CT during the follow-up period. The factors (gender, diabetes mellitus, atherosclerotic disease, smoking, entry site in arch, initial diameter, chronic obstructive pulmonary disease, blood pressure, and age) influencing increase in the diameter and growth rate were also evaluated. Of 177 segments, 132 segments (74.6%) increased in size during the follow-up period. The presence of blood flow in the false lumen was the only significant risk factor for increase in the diameter in the univariate and multivariate analysis. The group with blood flow in the false lumen had a significantly higher mean growth rate (3.3 mm/year) than the group without blood flow (Ϫ1.4 mm/year) (PϽ0.0001). The growth rate of aortic dissections in thoracic aorta and abdominal aorta were 4.1 and 1.2 mm/year, respectively. There was a significant difference in the growth rate between the 2 groups (Pϭ0.0003). Conclusion-In type B aortic dissection, the affected aortas have shown a high incidence of enlargement during the follow-up period, and more careful follow-up study is needed for aortic dissections in the thoracic aorta. The presence of blood flow in the false lumen is the most important risk factor for aortic enlargement.

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Section: Discussionmentioning

confidence: 68%

Growth Rate of Aortic Diameter in Patients With Type B Aortic Dissection During the Chronic Phase

Sueyoshi

Sakamoto²,

Hayashi³

et al. 2004

Circulation

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166

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“…6 -9,12 Few studies exist on the predictors of medium-to long-term evolution patterns of IMH, and most of them are retrospective. 17,18,22,23 Furthermore, the results of the 2 major studies, 17,18 which used only clinical and radiological findings, show some disagreement. Our study represents a definite improvement on the previous information for the following reasons.…”

Section: Discussionmentioning

confidence: 99%

“…These findings concur with those of previous studies, which reported similar results of IMH regression or persistence in a short-term follow-up. 12,16 Recently, Sueyoshi et al 17 reported that an aortic diameter less than 40 mm and a thickness less than 10 mm identified the type B IMH regression group. By contrast, Ganaha et al 18 suggested that the presence of penetrating atherosclerotic ulcer in acute phase was the factor that predicted progression or regression of IMH, with maximum aortic diameter lacking prognostic value.…”

Section: Prognostic Factorsmentioning

confidence: 99%

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16] Recent studies using clinical and radiological findings identified prognostic markers associated with medium-term IMH progression or regression, with conflicting results. 17,18 Therefore, additional studies using a wider range of imaging techniques are required to determine the predictive factors of long-term evolution of IMH. 19 The aim of the present study was to assess prospectively the long-term clinical and morphological evolution of medically treated IMH using multiple imaging techniques in a series of consecutive patients from a single hospital surviving the acute phase of the disease.…”

mentioning

confidence: 99%

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Long-Term Follow-Up of Aortic Intramural Hematoma

Evangelista¹,

Domínguez²,

Sebastiá³

et al. 2003

Circulation

190

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Background-Aortic intramural hematoma (IMH) evolves very dynamically in the short-term to regression, dissection, or aortic rupture. The aim of the present study was to assess the long-term clinical and morphological evolution of medically treated IMH. Methods and Results-Fifty of 68 consecutive patients with aortic IMH monitored clinically and by imaging techniques at 3, 6, and 12 months and annually thereafter were prospectively studied. Mean follow-up was 45Ϯ31 months. In the first 6 months, total IMH regression was observed in 14 and progression to aortic dissection in 18 patients; in 14 of these, the dissection was localized, and 12 later developed pseudoaneurysm. At the end of follow-up, the IMH had regressed completely without dilatation in 17 patients (34%), progressed to classical dissection in 6 (12%), evolved to fusiform aneurysm in 11 (22%), evolved to saccular aneurysm in 4 (8%), and evolved to pseudoaneurysm in 12 (24%). Evolution to dissection was related to echolucency (PϽ0.02) and to longitudinal extension of IMH (PϽ0.01). Multivariate analysis showed an independent association between regression and smaller maximum aortic diameter and between aneurysm formation and atherosclerotic ulcerated plaque and absence of echolucent areas in IMH. Conclusions-The most frequent long-term evolution of IMH is to aortic aneurysm or pseudoaneurysm. Complete regression without changes in aorta size is observed in one third of cases, and progression to classical dissection is less common. A normal aortic diameter in the acute phase is the best predictor of IMH regression without complications, and absence of echolucent areas and atherosclerotic ulcerated plaque are associated with evolution to aortic aneurysm.

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“…10). [25][26][27] These observations are important as they demonstrate that noninvasive imaging modalities including TEE is useful not only for correct differential diagnosis but for risk stratification and selection of treatment strategy.…”

mentioning

confidence: 99%

Update on Acute Aortic Syndrome

Song

2005

Korean Circ J

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For the last decade, we have witnessed dramatic changes in both diagnostic and therapeutic aspects of acute aortic syndrome (AAS). With recent advances of various noninvasive aortic pathology imaging modalities, aortic intramural hematoma (AIH), a variant form of classic aortic dissection (AD), has emerged as an increasingly recognized and potentially fatal AAS entity. As the natural course of AD and AIH, especially with medical treatment, has been reported quite different, there has been a suggestion of applying different treatment strategies based not only on the affected sites of the aorta but also the different AAS entities, which is still in debate. Endovascular stent-graft placement is a revolutionary change in the treatment of various aortic pathologies including AAS. In the next decade, dramatic changes in clinical practice and outcome for patients with AAS are expected using new diagnostic information to select the best treatment option for individual patients.

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Analysis of predictive factors for progression of type B aortic intramural hematoma with computed tomography

Cited by 99 publications

References 15 publications

Growth Rate of Aortic Diameter in Patients With Type B Aortic Dissection During the Chronic Phase

Growth Rate of Aortic Diameter in Patients With Type B Aortic Dissection During the Chronic Phase

Long-Term Follow-Up of Aortic Intramural Hematoma

Update on Acute Aortic Syndrome

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