Long-Term Outcome of Type B Aortic Intramural Hematoma: Comparison With Classic Aortic Dissection Treated by the Same Therapeutic Strategy

Current Understandings and Approach to the Management of Aortic Intramural Hematomas

“…As with type A IMH, aortic diameter and thickness have been consistent predictors of progression to rupture, dissection, or dilation. 29,30,39,40 Sueyoshi et al 39 reported a diameter of 440 mm (P ¼ 0.001 with a hazard score of 30) and aortic wall thickness of 10 mm (P ¼ 0.009 with a hazard score of 9) were significant predictors of IMH progression. Kaji reported that age 470 years, ulcerlike plaques in the aorta, wall thickness 412 mm, and diameter 442 mm were predictors.…”

“…Reports of the rate to progression to AD are variable both in frequency and in time interval. 30,[39][40][41] Between 20 days and 36 months after diagnosis, Sueyoshi et al 39 described 11% (4/35) progressing from IMH to AD, 2 of which were type A dissections. Progression from a descending IMH to an AD is not uncommon among published series.…”

“…Reported rates of rupture in type B IMH range from 4%-38%. 29,39,40 Rupture has reported to occur over a broad time period ranging from presentation to months after index presentation. Although the variability of reports are undoubtedly affected by the small sample size, most published series and registries report the occurrence of early and late rupture in "stable" medically managed patients, which should be of concern to practitioners who care for these patients in both the acute and chronic phase, as aortic disease can silently progress.…”

Early Aggressive Medical Treatment Associated with Selective Prophylactic Aortic Stent-Grafting for Aortic Intramural Hematoma

“…Discussion ! Recent advances in imaging techniques have significantly improved the diagnosis and clinical understanding of IMH [16,17]. However, a consensus has not been reached regarding the optimal management strategies for IMH.…”

Optimal management of acute aortic dissection

“…The observed in-hospital mortality rate for uncomplicated type B aortic dissection for hemodynamically stable patients in the absence of branch vessel involvement and periaortic hematoma is 1% [18]. Type B aortic intramural hematomas have the same survival and complication rates as type B aortic dissection, using a similar therapeutic strategy [19]. The occurrence of hypotension/shock (OR for mortality, 23.8; P < 0.0001), absence of chest/back pain on presentation (OR, 3.5; P < 0.01), and branch vessel involvement (OR, 2.9; P = 0.01) are independent predictors of in-hospital mortality in this setting [17].…”