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Semin Thorac Cardiovasc Surg. 2018 Autumn;30(3):279-287. doi: 10.1053/j.semtcvs.2018.02.006. Epub 2018 Feb 9.

Best Medical Treatment and Selective Stent-GraftRepair for Acute Type B Aortic Intramural Hematoma.

Author information

1
Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy. Electronic address: gabriele.piffaretti@uninsubria.it.
2
Vascular Surgery II and Thoracic Aortic Research Center, IRCCS Policlinico San Donato Teaching Hospital, University of Milan School of Medicine, Milan, Italy.
3
Vascular Surgery, Department of Cardiovascular and Thoracic Sciences, "G. Martino" University Teaching Hospital, University of Messina School of Medicine, Messina, Italy.
4
Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.
5
Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, Careggi University Teaching Hospital, University of Florence School of Medicine, Florence, Italy.

Abstract

This study aimed to describe our experience with the management and the results of stent-graft (SG) repair of acute type B aortic intramural hematoma (B-IMH). Between January 2005 and July 2016, we identified 41 B-IMHs. Major end points were early and long-term survival, aortic remodeling, freedom from aortic-related mortality (ARM), and freedom from reintervention. Thirty-one (76%) patients eventually underwent SG repair: 16 (52%) cases in the acute phase, and 6 (19%) in the subacute (14-30 days) phase. Nine (29%) patients showed aortic lesion progression in the follow-up despite best medical treatment, and required SG repair in the chronic phase. The presence of ulcer-like projections at the admission computed tomography angiography was significantly higher in patients who eventually required SG repair (5% vs 36%, odds ratio: 4.08, P = .043). At 12 months, whereas ARM showed a trend in favor of SG (84% ± 10 vs 100%; log-rank: P = .075), the freedom from aortic progression was significantly lower in the SG group (64% ± 13 vs 94% ± 5; log-rank: P = .002). Median follow-up was 31 months (range, 2-96; interquartile range, 11-62.5). Freedom from ARM and freedom from aortic reintervention was 92% ± 5 (95% confidence interval: 75-98) at 12 months. Aortic remodeling was observed in 26 (84%) patients. No differences were noted between patients treated with SG in the acute and in the chronic phase. In our experience, B-IMH was associated with 47% aortic adverse event rate in the follow-up with best medical treatment alone. At mid-term, results of SG repair are encouraging.

KEYWORDS:

B intramural hematoma; TEVAR; best medical treatment; ulcer-like projection

PMID:
29432889
DOI:
10.1053/j.semtcvs.2018.02.006
[Indexed for MEDLINE]

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