Aortic Branch Artery Pseudoaneurysms Associated with Intramural Hematoma: When and How to Do Endovascular Embolization

作者：Ferro Carlo; Rossi Umberto G^*; Seitun Sara; Scarano Flavio; Passerone Giancarlo; Williams David M

来源：CardioVascular and Interventional Radiology, 2013, 36(2): 422-432.

DOI：10.1007/s00270-012-0512-z

• Thoracic aorta
• Intramural hematoma
• Pseudoaneurysm
• Embolization

To describe when and how to perform endovascular embolization of aortic branch artery pseudoaneurysms associated with type A and type B intramural hematoma (IMH) involving the descending thoracic and abdominal aorta (DeBakey I and III) that increased significantly in size during follow-up.
Sixty-one patients (39 men; mean +/- A standard deviation age 66.1 +/- A 11.2 years) with acute IMH undergoing at least two multidetector computed tomographic examinations during follow-up for 12 months or longer were enrolled. Overall, 48 patients (31 men, age 65.9 +/- A 11.5) had type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III).
Among the 48 patients, 26 (54 %; 17 men, aged 64.3 +/- A 11.4 years) had 71 aortic branch artery pseudoaneurysms. Overall, during a mean follow-up of 22.1 +/- A 9.5 months (range 12-42 months), 31 (44 %) pseudoaneurysms disappeared; 22 (31 %) decreased in size; two (3 %) remained stable; and 16 (22 %) increased in size. Among the 16 pseudoaneurysms with increasing size, five of these (three intercostal arteries, one combined intercostobronchial/intercostal arteries, one renal artery), present in five symptomatic patients, had a significant increase in size (thickness > 10 mm; width and length > 20 mm). These five patients underwent endovascular embolization with coils and/or Amplatzer Vascular Plug. In all patients, complete thrombosis and exclusion of aortic pseudoaneurysm and relief of back pain were achieved.
Aortic branch artery pseudoaneurysms associated with type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III) may be considered relatively benign lesions. However, a small number may grow in size or extend longitudinally with clinical symptoms during follow-up, and in these cases, endovascular embolization can be an effective and safe procedure.

• 出版日期2013-4