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Aortic Intimo-intimal Intussusception: A Pooled Analysis of Published Reports.
Zhi-Yuan Wu1, Yu-Qing Miao2, Christoph Knappich3
1Department of Vascular and Endovascular Surgery, Technical University of Munich, Munich, Germany; Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China.
Annals of Vascular Surgery
|April 8, 2021
Summary
Aortic intimo-intimal intussusception (AoII) is a rare aortic dissection with high mortality. Understanding flap orientation is key, as antegrade AoII links to neurological issues and retrograde AoII to aortic regurgitation.
Area of Science:
- Cardiovascular Surgery
- Vascular Medicine
- Diagnostic Imaging
Background:
- Aortic intimo-intimal intussusception (AoII) is a rare and often fatal complication of aortic dissection.
- Limited understanding exists regarding the clinical spectrum and outcomes of AoII.
Purpose of the Study:
- To comprehensively analyze the demographics, clinical presentation, diagnostic methods, and outcomes of patients with aortic intimo-intimal intussusception.
- To elucidate the differences in clinical manifestations and associated conditions based on the intimal flap orientation in AoII.
Main Methods:
- A systematic literature review was conducted across PubMed, Scopus, and Embase databases.
- Search terms included variations of "intimal intussusception" and "aortic dissection" with circumferential intimal dissection.
- Data extracted included patient demographics, clinical symptoms, imaging findings, therapeutic interventions, and follow-up outcomes.
Main Results:
- Eighty-seven patients with AoII were identified from 81 studies, with a mean age of 53.7 years and a male predominance (63/87).
- Patients were categorized into antegrade (n=37), retrograde (n=49), and bidirectional (n=1) flap orientations.
- Antegrade AoII was associated with chest pain, syncope, and unconsciousness; retrograde AoII with chest pain, dyspnea, and back pain. Mortality was 24.1%, with 13.8% dying pre-operatively.
Conclusions:
- AoII is a rare aortic dissection variant with significant mortality.
- Antegrade intimal flap orientation correlates with neurological symptoms and blood pressure asymmetry, while retrograde orientation is linked to aortic regurgitation.
- Utilizing multiple imaging modalities is crucial for timely diagnosis of this rare condition.
