10.1177/1056789514562152

Vollständiger Abstract

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<h4>Purpose</h4>To analyse predictors of aortic complications (ACs) and outcomes of patients admitted for acute type B intramural haematoma (IMH-B).<h4>Methods</h4>A retrospective analysis of data of patients diagnosed with acute IMH-B from 7 French tertiary centres between December 2003 and December 2019 was conducted. Baseline demographics, initial anatomical features, indication and treatment modality during the acute phase including either thoracic endovascular aortic repair (TEVAR) and optimal medical therapy (OMT) or OMT alone were recorded. The primary endpoint was the occurrence of any AC during follow-up, defined as a composite criterion including aortic rupture, ulcer-like projection, aortic dissection or aneurysmal degeneration. Secondary endpoints included freedom from all-cause mortality and from aortic-related intervention.<h4>Results</h4>Eighty-one patients (52% male, median age 72 [62-77]) were included. Medical therapy initiated during the acute phase included more than 2 antihypertensive drugs in 39 (48%) patients. Nine patients (11%) underwent urgent (<24 hours) TEVAR for frank or impending rupture. Fourteen (19%) underwent TEVAR within 30 days for OMT failure. Of these, 8 were AC-related including 6 patients treated for rapid aortic growth. The overall 30-day mortality was 4.9% (n = 4), 2 patients died after TEVAR. The median follow-up was 34 months (7-53). Overall, 43 ACs occurred at a median time of 6 months (1-36). The 1- and 3-year estimate survival and freedom from AC were 88% (81-96) and 86% (78-95), and 60% (50-73) and 53% (42-67), respectively. By Cox regression analysis, previous aortic surgery (hazard ratio [HR] = 3.5 [1.2-10.3]; <i>P</i> = .025) and the maximum aortic true lumen diameter at admission (HR [per 1 mm increment] = 1.07 [1.02-1.13]; <i>P</i> = .009) were predictors of AC.<h4>Conclusion</h4>After acute type B IMH, ACs are most prevalent within the first year, mandating close early clinical and imaging follow-up. Larger presenting aortic lumen maximum diameter is associated with increased likelihood of AC.Clinical ImpactIntramural haematoma (IMH) is a rare condition. While invasive treatment with thoracic stent-grafts has become the standard of care for complicated cases, treatment indications during the acute phase remain a matter of debate, and the natural history of the condition is not fully understood. This study, which included 81 patients with type B IMH (IMH-B), suggests that a presenting aortic lumen diameter greater than 27 mm and a history of aortic surgery are predictive for the risk of ACs after acute IMH-B, mandating closer imaging and clinical monitoring.

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