Aortic intramural hematoma and classic aortic dissection: two sides of the same coin within the acute aortic syndrome for an interventional radiologist

Abstract

management of acute type B aortic intramural hematoma (AIH) still represents a challenging issue. Although most resolve spontaneously or with conservative therapy, several cases of AIH may complicate into classic aortic dissection with subsequent risk of aortic rupture and visceral malperfusion, thus needing urgent or preemptive thoracic endovascular aneurysm repair (TEVAR). Despite the long-term aorta-related survival, TEVAR might lead to graft obstruction, migration, infection, stroke/paraplegia, visceral ischemia, endoleak and, last but not least, retrograde aortic dissection (AD), frequent in the acute phase and associated with a high mortality risk. In order to highlight such a close relationship between AIH and AD and the possibility to perform endovascular treatment, we report the experience of an adult female patient with an aortic intramural hematoma evolving into a classic aortic dissection. Despite successful thoracic endovascular aneurysm repair (TEVAR), our patient developed an aortic dissection type A at one month with subsequent indication for cardiac surgery, still representing the elective approach in case of pathologies including the ascending aorta. Thus, the aim of our discussion is to create a debate on the most appropriate management for the treatment of descending AIH.

Intramural hematoma in the proximal sealing zone of the thoracic endovascular aneurysm repair: frequency and safety in acute and subacute type B dissections

“…Those smaller inhomogenous cohorts were successfully treated by TEVAR and had comparable results with open surgery going hand in hand with less postoperative morbidity ( 19 , 20 , 21 ). Other authors reported the occurrence of RTAD after the TEVAR treatment of the type B IMH with a diseased proximal sealing zone (affected by the IMH) ( 22 ).…”

“…Endoleaks type I (total) n (%) (19,20,21). Other authors reported the occurrence of RTAD after the TEVAR treatment of the type B IMH with a diseased proximal sealing zone (affected by the IMH) (22). The current study reports the high incidence of IMH in the proximal TEVAR landing zones in TBD, compares the outcomes of patients with and without the IMH at the proximal stent-graft end, and reports comparable results regarding RTAD, bird-beak formation, and stent-graft migration.…”

A Rare Initial Presentation of Aortic Intramural Hematoma: A Case Report and Literature Review

“…While the management of Stanford Type-A AIH is debated within the current literature, recent reviews have recorded better outcomes in those managed surgically versus medically [ 14 ]. On the other hand, Type-B AIH is regularly managed medically with hemodynamic control [ 15 ].…”