Current trends in aortic intramural hematoma management—a shift from conservative to a more aggressive treatment

Σπανός, Κωνσταντίνος; Kölbel, Tilo; Giannoukas, Athanasios D.

doi:10.21037/acs.2019.06.02

Cited by 9 publications

(7 citation statements)

References 11 publications

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“…The diagnosis of aortic IMH can easily be missed because it is relatively uncommon and CT findings can be subtle. 1 The most common cause of aortic IMH is thought to be spontaneous rupture of the vasa vasorum, the tiny blood vessels that nourish the thick-walled aorta. 2 Microscopic tears in the intima, aortic ulcerations, and thoracic trauma are other less common causes.…”

Section: Intramural Hematoma Of the Aorta (Stanford Type A)mentioning

confidence: 99%

“…2 Although IMH may reabsorb, as many as 88% progress to aortic dissection and approximately 20% result in aortic rupture. 1 Non-contrast CT often shows crescent-shaped areas of relative hyperattenuation along the aortic wall, without an intimal flap (Figure 2). Because it is separated from the intima, the area of interest fails to enhance after intravenous contrast (Figures 3 and 4).…”

Section: Intramural Hematoma Of the Aorta (Stanford Type A)mentioning

confidence: 99%

“…Aortic IMH may be more difficult to identify on imaging than dissection, partly because there is no dissection flap. The diagnosis of aortic IMH can easily be missed because it is relatively uncommon and CT findings can be subtle 1 …”

Section: Diagnosismentioning

confidence: 99%

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A unique cause of severe chest pain in the emergency department

Starrs

Zafren

2023

JACEP Open

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Section: Intramural Hematoma Of the Aorta (Stanford Type A)mentioning

confidence: 99%

Section: Intramural Hematoma Of the Aorta (Stanford Type A)mentioning

confidence: 99%

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A unique cause of severe chest pain in the emergency department

Starrs

Zafren

2023

JACEP Open

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“…1 An increased number of patients has been successfully treated with endovascular approach, which indicates improvements with the use of older and novel devices and experience gained so far. 2 Our aim was to present our initial experience with the use of a new generation thoracic device in two patients who presented with acute aortic syndrome. For both patients, we obtained informed consent for using anonymous data and images for research purposes.…”

Section: Introductionmentioning

confidence: 99%

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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“…Hematoma thickness >11 mm is also predictive of adverse events-independent of the maximum aortic diameter. 2 Differential diagnosis of ICA includes intramural blood pool (IBP) and an ulcer-like projection (ULP) both of them are associated with IH. IBP is defined as a focal contrast-enhancing collection within an intramural hematoma with a narrow or non-discernible communication with the aortic lumen.…”

Section: Introductionmentioning

confidence: 99%

Aortic Intramural Hematoma due to Intercostal Artery Aneurysms

Wolf

Ajaj

Greton

et al. 2021

Vasc Endovascular Surg

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Background Intercostal artery aneurysms (ICA) are rare vascular disease. A rupture of ICA is a possible mechanism of intramural aortic hematoma (IH). We report a case with IH and ICAs without clear etiology. Case presentation: A 64-year-old man was admitted to our emergency room with a sudden onset of acute diffused abdominal and chest pain, radiating to the back. Without previous traumatic insult, a computed tomographic angiography scan (CTA) revealed an IH beginning inferior to the left subclavian artery extending to the level of the celiac trunk. Follow-up CTA demonstrated a stable maximal IH thickness diameter of 11 mm, maximal aortic diameter of 40 mm, a new left hemorrhagic pleural effusion, and a focal contrast enhancement at T9 level. Due to these findings, thoracic endovascular aortic repair (TEVAR) was performed. During follow up, T9 focal enhancement continues to grow and an additional one developed. Selective angiography was performed demonstrating a connection to the costal artery and the aortic lumen, confirming ICA. Successful embolization with micro coils was performed. During follow up, additional 2 ICAs developed and treated with embolization. CTA three months later showed a complete resolution of the IH and obliteration of all treated ICAs. Infectious, inflammatory and connective tissue disease investigations were undertaken without a clear etiology. Conclusions: This is a case of IH and ICAs, in the absence of a clear etiology which were successfully treated by endovascular procedures TEVAR and coil embolization. It is not clear whether the hematoma was the source of the ICA or the other way round. Lack of ICAs in the initial CTA might be due to the pressure exerted by the hematoma or that they were too small to be detected but continued to grow on follow up. Rupture of these micro-aneurysms is a possible mechanism of intramural aortic hematoma.

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Current trends in aortic intramural hematoma management—a shift from conservative to a more aggressive treatment

Cited by 9 publications

References 11 publications

A unique cause of severe chest pain in the emergency department

A unique cause of severe chest pain in the emergency department

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

Aortic Intramural Hematoma due to Intercostal Artery Aneurysms

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