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

OBJECTIVES:
To describe our experience with the management and the results of stent-graft (SG) repair of acute type B aortic intramural hematoma (B-IMH).

METHODS:
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.

RESULTS:
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 (BMT), 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%, OR: 4.08, P = .043). At 12 months, while 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; IQR, 11-62.5). Freedom from ARM and freedom from aortic reintervention was 92% ± 5 (95%CI: 75-98) at 12 months. Aortic remodeling was observed in 26 (84%) patients. No differences were noted between patients treated with SG in acute vs. chronic phase.

CONCLUSIONS:
In our experience, B-IMH was associated with 47% aortic adverse event rate in the follow-up with BMT alone. At mid-term, results of SG repair are encouraging.