Endovascular versus medical management of type B intramural hematoma: a meta-analysis

Abstract

Background: Aortic intramural hematoma constitutes one of the three classifications of acute aortic syndrome (AAS). Type B intramural hematoma (IMH-B) is localized to the descending thoracic aorta and can be managed through medical, endovascular or surgical means. Data comparing contemporary management with thoracic endovascular aortic repair (TEVAR) versus traditional medical management (MM) is sparse and only moderate strength recommendations for TEVAR are provided in guidelines. This meta-analysis aimed to pool available data from comparative studies between TEVAR and MM and examine differences in outcomes. Methods: Literature search of electronic medical databases was conducted to identify studies comparing TEVAR and MM for management of IMH-B. Data extraction from studies fulfilling the inclusion criteria was performed by two authors and meta-analysis using a random-effects model applied to pool baseline data and examine risk ratios (RR) for management outcomes. Results: Of the initial 2,349 studies, nine studies were identified for analysis. There were 161 TEVAR patients and 166 who were medically managed. The mean age of the cohort was 62.2 years [95% confidence interval (CI): 55.8-68.7 years]. Patients with complicating features of IMH-B at presentation were more likely to appear in the TEVAR group, with more penetrating atheromatous ulcer (PAU) [risk difference (RD)

‘Ulcer-like projection’ in uncomplicated acute type B intramural haematoma: might we prevent or protect from an unexpected event?

“…Furthermore, at least one-third of the observed B-IHM was lost during follow-up, thus we can presume that this high rate of adverse progression of ULP might be even higher. Baseline data meta-analysis showed patients with complicating features of ULP were more likely to be managed with thoracic endovascular aortic repair (TEVAR), and when selective TEVAR was used in B-IMH with ULP progression, it was found to be associated with lower risk of dissection and lower risk of rupture during follow-up [4].…”

Prognostic value of clinical and morphologic findings in patients with type B aortic intramural hematoma

“…For simple type B IMH, 6 patients received endovascular repair for refractory pain in 3, progression to aortic dissection in 2 and aneurysm in 1, while the rest were managed with OMT. As optimal therapeutic strategy for type B IMH remains debated [14,15], we compared the outcomes of surgery combined with OMT and OMT only in all patients. As shown in Fig.…”

Long-Term Thoracic Endovascular Repair Follow-Up from 1999 to 2019: A Single-Center Experience

“…9,10 Acute aortic syndrome (AAS) consists of complicated type B dissections, symptomatic penetrating aortic ulcers (PAUs), intramural hematoma (IMH), or unstable and/or ruptured aneurysms which include and require urgent intervention. 5,7,11,12 However, chronic aortic conditions, for example, uncomplicated type B dissections, and stable PAU, IMH, and stable aneurysms can be electively and selectively treated.…”