Endovascular repair of acute zone 0 intramural hematoma with most proximal tear or ulcer-like projection in the descending aorta

Objective: In the present study, we have reported the midterm results of endovascular repair of acute zone 0 intramural hematomas (IMHs) with the most proximal tear or ulcer-like projection (ULP) in the descending aorta.

Methods: Data from patients with acute zone 0 IMH with the most proximal tear or ULP in the descending aorta from January 1, 2010, to December 31, 2019, were retrospectively reviewed. We performed Kaplan-Meier curves to calculate the intervention-free survival and survival after endovascular or open surgical repair. We used propensity score matching to compare the outcomes of endovascular and open surgical repair.

Results: The present study included 99 patients. Of the 99 patients, 34 had initially received medical treatment. The 0.5-, 1-, and 3-year intervention-free survival rates for the 34 patients were 23.5%, 17.6%, and 14.7%, respectively. Of the 99 patients, 51 had undergone endovascular therapy, 27 after initial medical treatment. Most of these 51 patients had had a maximal diameter of the ascending aorta of <50 mm and a maximal diameter of IMH in the ascending aorta of <10 mm. The 1-, 3-, and 5-year survival rate for the endovascular group was 98.0%. Finally, 42 patients had undergone open surgery (3 after medical treatment), and the 1-, 3-, 5-year survival rates were all 92.9%. After propensity score matching, no statistically significant difference was found in the 30-day and follow-up mortality. However, endovascular repair was associated with a shorter operation time (69 vs 314 minutes; P < .001), shorter length of intensive care unit stay (24 vs 70 hours; P = .001), and shorter length of hospital stay (7 vs 12 days; P = .011).

Conclusions: For patients with acute zone 0 IMH and the most proximal tear or ULP in the descending aorta, in addition to open surgery, endovascular repair is an option if the maximal diameter of the ascending aorta is <50 mm and the maximal diameter of the IMH in the ascending aorta is <10 mm.