Clinical study
Outcomes of medically treated patients with aortic intramural hematoma

https://doi.org/10.1016/S0002-9343(02)01171-3Get rights and content

Abstract

Purpose

Aortic intramural hematoma has been considered a precursor of aortic dissection, and the same treatment strategy, usually involving surgery, has been applied to both conditions. However, the outcomes of patients with aortic intramural hematoma who are treated medically, including the remodeling process that occurs after an acute event, are not known.

Subject and methods

A total of 124 patients with acute aortic intramural hematoma (41 in the proximal aorta and 83 in the distal aorta) was enrolled from five institutions in South Korea. Patients received medical treatment without surgery. A follow-up imaging study was performed in 105 patients.

Results

Pericardial (59% [n = 24] vs. 11% [n = 9], P <0.004) and pleural effusions (63% [n = 26] vs. 45% [n = 37], P = 0.05) were more common in patients with the proximal type than in those with the distal type. In-hospital mortality was somewhat higher with proximal hematomas (7% [n = 3 deaths] vs. 1% [n = 1 death], P = 0.11). A follow-up imaging study in 36 patients with proximal hematomas confirmed resorption of the hematoma in 24 patients (67%) and development of aortic dissection in 9 (25%). Resorption was confirmed in 54 (78%) of the 69 patients with distal hematomas who underwent follow-up imaging; localized aortic dissection developed in 11 (16%) of these patients. The 3-year survival rate was 78% in the proximal type and 87% in the distal type (P = 0.10).

Conclusion

Patients with aortic intramural hematoma had a high rate of resorption with medical treatment regardless of the affected site. Further investigation is necessary to determine the optimal treatment strategy and timing of surgical intervention, especially for patients with proximal hematomas.

Section snippets

Methods

A database of patients with acute aortic syndrome from 1997 to 1999 was reviewed at each of five large referral centers in South Korea. Patients with acute aortic intramural hematoma who received medical treatment without surgical intervention during the acute stage (within 2 weeks after the onset of chest or back pain) were enrolled. During the study period, 3 patients with proximal hematomas underwent urgent surgical repair due to unstable hemodynamic condition within 24 hours after symptom

Results

A total of 124 patients were enrolled, 41 of whom showed involvement of the ascending aorta and were classified as the proximal type; the remaining 83 patients showed involvement of the descending aorta only and were classified as the distal type. The mean (± SD) age of the patients was 63 ± 10 years; more than three quarters had hypertension (Table 1). Pericardial and pleural effusions were more common in patients with the proximal type (Table 1). In-hospital mortality was somewhat greater

Discussion

In this multicenter study, we found that those patients with aortic intramural hematoma show high rates of resorption with medical treatment, regardless of the affected site. Typical aortic dissection develops only in a few patients, perhaps indicating that the absence of a direct-flow communication through an intimal tear in aortic intramural hematoma is a good prognostic finding. This is consistent with observations in classic aortic dissection, in which persistent flow in the false lumen

References (26)

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This study was supported by a grant from the Korean Circulation Society (#98-7).

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