Acute Type B Aortic Intramural Hematoma: Treatment Strategy and the Role of Endovascular Repair

作者：Li, Dong-lin; Zhang, Hong-kun^*; Cai, Yang-yang; Jin, Wei; Chen, Xu-dong; Tian, Lu; Li, Ming

来源：Journal of Endovascular Therapy, 2010, 17(5): 617-621.

DOI：10.1583/10-3125.1a

• thoracic aorta
• intramural hematoma
• endovascular repair
• stent-graft
• medical treatment
• penetrating aortic ulcer
• outcome analysis

Purpose: To report a prospective study that explored the therapeutic strategies in the treatment of type B aortic intramural hematoma (IMH) and evaluated the role of endovascular repair. @@@ Methods: Between January 2001 and December 2009, 56 consecutive patients were enrolled in a prospective study to evaluate stent-graft repair versus medical therapy for acute type B IMH (patients with type A IMH excluded). Patients who had penetrating atherosclerotic ulcers, maximum aortic diameter >45 mm, hematoma thickness >10 mm, or sustained chest or back pain despite maximal medical therapy received endovascular stent-grafts (n=33; mean age 60 years, range 33-86), while other patients (n=23; mean age 56 years, range 29-83) received conservative therapy. @@@ Results: Stent-grafts were implanted successfully as scheduled in 33 patients as elective procedures; there were no complications related to the procedure. The mean follow-up up was 28 15 months (range 3-108). In the medically treated patients, there were 6 (26%) cases of IMH progression (4 treated with stent-grafts) and 2 (9%) deaths versus no IMH progression or death in the stent-graft patients. The thickness of the hematoma was reduced in all 37 patients receiving stent-grafts, and the maximum aortic diameter decreased in 19 of these patients. The 17 surviving patients in the medical group also showed regression of the hematoma in follow-up. @@@ Conclusion: Type B IMH is a potentially lethal disease, and the application of endovascular stent-grafts achieved an encouraging result in this study. Therefore, a more optimistic strategy, including endovascular repair, should be considered and evaluated in the future. J Endovasc Ther. 2010;17:617-621

• 出版日期2010-10
• 单位浙江大学