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Outcomes of medically treated patients with aortic intramural hematoma
Jae-Kwan Song1, Hyun-Sook Kim, Jong-Min Song
1Division of Cardiology, Asan Medical Center, Seoul, South Korea. jksong@www.amc.seoul.kr
Insights
Medical management of aortic intramural hematoma shows high resorption rates. Further research is needed for optimal treatment strategies, particularly for proximal aortic intramural hematoma.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Medical Imaging
Background:
- Aortic intramural hematoma (AIH) is often viewed as a precursor to aortic dissection.
- Current treatment strategies for AIH typically mirror those for aortic dissection, often involving surgical intervention.
- Limited data exists on the outcomes and natural history of AIH managed non-surgically, including its remodeling process.
Purpose of the Study:
- To evaluate the outcomes of patients with acute aortic intramural hematoma treated exclusively with medical management.
- To investigate the remodeling process, including hematoma resorption and the development of aortic dissection, following non-surgical treatment of AIH.
- To compare outcomes between proximal and distal aortic intramural hematoma cases managed medically.
Main Methods:
- A cohort of 124 patients with acute aortic intramural hematoma was enrolled across five South Korean institutions.
- All patients received conservative medical treatment, with no surgical interventions performed.
- Follow-up imaging studies were conducted on 105 patients to assess hematoma resolution and disease progression.
Main Results:
- Pericardial and pleural effusions were more frequent in proximal AIH compared to distal AIH.
- In-hospital mortality was slightly higher in proximal AIH cases, though not statistically significant.
- Follow-up imaging revealed hematoma resorption in 67% of proximal AIH cases and 78% of distal AIH cases. Aortic dissection developed in 25% of proximal and 16% of distal cases.
Conclusions:
- Medical treatment leads to a high rate of hematoma resorption in patients with aortic intramural hematoma, irrespective of location.
- The findings suggest that non-surgical management may be a viable option for AIH.
- Further research is warranted to establish optimal treatment guidelines and the appropriate timing for surgical intervention, especially for proximal AIH.
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.