Clinical features and surgical outcomes of type A intramural hematoma

Shi, Yi; Dun, Yaojun; Guo, Hongwei; Liu, Yanxiang; Zhang, Bowen; Qian, Xiangyang; Yu, Cuntao; Sun, Xiaogang

doi:10.21037/jtd-20-748

Cited by 10 publications

(13 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As for CPB time, the study of Yi Shi et al. suggested that the length of CPB time (>200 min) was a risk factor for stroke, 23 and the clinical study of Antonio Salsano et al. also showed that CPB time was positively correlated with postoperative stroke.…”

Section: Discussionmentioning

confidence: 99%

Preoperative and intraoperative risk factors of postoperative stroke in total aortic arch replacement and stent elephant trunk implantation

Jia¹,

Huang²,

Kang³

et al. 2022

eClinicalMedicine

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Preoperative and intraoperative risk factors of postoperative stroke in total aortic arch replacement and stent elephant trunk implantation

Jia¹,

Huang²,

Kang³

et al. 2022

eClinicalMedicine

View full text Add to dashboard Cite

“…Renal insufficiency was considered to be associated with adverse aorta-related events in previous studies. 36 In the MT group, renal insufficiency was significantly associated with adverse aortic events, indicating that renal insufficiency plays an independent prognostic role for risk stratification. Prior studies on patients with kidney disease have reported an independent association between renal insufficiency and calcification in the aorta.…”

Section: Discussionmentioning

confidence: 93%

Outcomes of intramural hematoma involving the ascending aorta and extending into the descending thoracic aorta

Xia

et al. 2022

Journal of Vascular Surgery

View full text Add to dashboard Cite

Objective: The optimal treatment of intramural hematoma (IMH) involving the ascending aorta remains controversial. This study aimed to analyze the results of the management of patients with acute IMH involving the ascending aorta and extending into the descending thoracic aorta, to compare outcomes of descending thoracic endovascular aortic repair (TEVAR) with that of medical therapy (MT), and to assess the risk factors associated with adverse aortic events. Methods:We retrospectively analyzed all patients diagnosed with acute IMH involving the ascending aorta and extending into the descending thoracic aorta from January 2012 to December 2019. The primary end points during follow-up were aortic disease-related death and adverse aorta-related events that required surgical or endovascular treatment, such as aortic rupture, the progression of aortic disease, or endoleak.Results: We identified a total of 135 patients with acute IMH involving the ascending aorta and extending into the descending thoracic aorta, of whom 104 underwent descending TEVAR (group 1) and 31 were managed with MT (group 2). Freedom from adverse aorta-related events at 1, 3, and 5 years was significantly higher for patients who underwent descending TEVAR compared with those managed with MT (89.2%, 88.2%, and 84.0% vs 74.2%, 74.2%, and 74.2%, respectively; P ¼ .026). The 1-, 3-, and 5-year survival rates for patients in the descending TEVAR group was 100%, 100%, and 100%, respectively, which was significantly higher than the survival of the MT group: 93.5%, 93.5%, and 81.9%, respectively (P ¼ .002). On a univariate analysis among patients receiving MT, those who suffered adverse aorta-related events showed a higher prevalence of renal insufficiency (55.6% vs 9.1%; P ¼ .003). In MT patients, multivariate analysis showed that renal insufficiency was the only independent risk factor associated with adverse aorta-related events (hazard ratio, 8.691; 95% confidence interval, 2.056-36.737; P ¼ .003).Conclusions: Based on our study, compared with MT, descending TEVAR might be the more favorable treatment for patients with IMH involving the ascending aorta and extending into the descending thoracic aorta. Patients with renal insufficiency are more likely to experience adverse aorta-related events, which implies the need for subsequent intervention or an increased risk of mortality. The risk factor would be helpful for clinical decision-making.

show abstract

“…Endovascular repair seems feasible and safe with low peri-operative and long-term morbidity and mortality in experienced centers and selected cases. presence of hypertension (>80%), which is poorly controlled (40%) or untreated (30%) [12,13]. Smoking is also detected within the most common comorbidities (40%) [12,13].…”

Section: Key Pointsmentioning

confidence: 99%

“…presence of hypertension (>80%), which is poorly controlled (40%) or untreated (30%) [12,13]. Smoking is also detected within the most common comorbidities (40%) [12,13]. Half of patients will present to the hospital within the first 24 h after symptoms' onset [12].…”

Section: Key Pointsmentioning

confidence: 99%

“…Half of patients will present to the hospital within the first 24 h after symptoms' onset [12]. Any type of pain, mainly chest or back pain, is present in 90% of cases while only 4% will arrive with syncope or hemodynamic instability [11][12][13]. Less cases will report symptoms related to cerebral, renal and spinal cord ischemia (5%) or acute heart failure (1%) [11][12][13].…”

Section: Key Pointsmentioning

confidence: 99%

See 1 more Smart Citation

Ascending aortic intramural hematoma: current concepts

Nana

Kouvelos

Σπανός

2022

Current Opinion in Cardiology

View full text Add to dashboard Cite

Purpose of reviewType A intramural hematoma (TAIMH) is an acute aortic disease characterized by the presence of hematoma in the aortic media and involving the ascending aorta. Open repair seems to be the first treatment approach, although recent evidence highlights that the best management of TAIMH is controversial. This review will focus on the current concept for TAIMH management and factors affecting the decision making.Recent findingsRecent studies have evaluated the role of open and endovascular repair, as well as conservative management in patients with TAIMH. More specific imaging findings seem to affect decision making for urgent repair.SummaryDespite TAIMH's acute nature, conservative management seems to represent a valid option for urgent approach, presenting similar mortality to open and endovascular repair. Comparative data are limited, however, in experienced centers, any approach may be applied with encouraging results. Endovascular management, which is mainly applied to manage retrograde TAIMH, is related to lower mortality and morbidity compared to open repair in this group of patients while aortic remodeling seems beneficial with this approach. Imaging findings, as ulcer-like lesions, hematoma thickness, concomitant dissection and aortic diameter, related to higher complication rate, set the indication for interventional management. Further research, including prospective data and registries, and ideally, randomized data may further clarify the best approach and factors indicating urgent repair.

show abstract

Clinical features and surgical outcomes of type A intramural hematoma

Cited by 10 publications

References 27 publications

Preoperative and intraoperative risk factors of postoperative stroke in total aortic arch replacement and stent elephant trunk implantation

Preoperative and intraoperative risk factors of postoperative stroke in total aortic arch replacement and stent elephant trunk implantation

Outcomes of intramural hematoma involving the ascending aorta and extending into the descending thoracic aorta

Ascending aortic intramural hematoma: current concepts

Contact Info

Product

Resources

About