Watch-and-wait strategy for selected patients with type A intramural hematoma

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Type A intramural hematoma (IMH) is a variant of aortic dissection.
• Management strategies for Type A IMH vary, with a need to identify optimal treatment pathways.

Purpose of the Study:

• To evaluate the early and midterm outcomes of a watch-and-wait strategy for Type A IMH.
• To compare outcomes between watch-and-wait and emergency surgical repair in selected patients.

Main Methods:

• Retrospective analysis of 100 consecutive patients with Type A IMH.
• Watch-and-wait criteria: maximum aortic diameter <50 mm, pain score <3/10, no ulcer-like projection.
• Primary endpoints: all-cause and aorta-related deaths; Secondary endpoint: aortic events.

Main Results:

• 52 patients received watch-and-wait; 48 underwent emergency repair.
• No significant difference in in-hospital mortality, 5-year survival, or 5-year freedom from aorta-related death between groups.
• Watch-and-wait group: 5-year freedom from aortic events was 60%.

Conclusions:

• A watch-and-wait strategy is favorable for Type A IMH patients meeting specific criteria (diameter ≤50 mm, pain ≤3/10, no ulcer-like projection).
• This approach resulted in no aorta-related deaths in the study cohort.
• Early and midterm outcomes support watch-and-wait as a safe management option for select Type A IMH cases.