Article Sidebar

PDF
Date Published: 26/01/2021
Online Published: 26/01/2021
Abstract Views: 108
Views PDF: 102
DOI: https://doi.org/10.47972/vjcts.v29i.465
Issue
Vol. 29
Section
Research Article
How to Cite
Vo, T. A., Nguyen, T. H. N., & Nguyen, H. D. (2021). Roles of endovascular treatment in aortic intramural hematoma. The Vietnam Journal of Cardiovascular and Thoracic Surgery, 29, 68-75. https://doi.org/10.47972/vjcts.v29i.465

Roles of endovascular treatment in aortic intramural hematoma

Tuan Anh Vo , Thoi Hai Nguyen Nguyen, Hoang Dinh Nguyen

Main Article Content

Abstract

Background – Objectives: Intramural hematoma (IMH) is a part of the acute aortic syndrome. Treatment of this disease remains controversial, including optimal medical treatment, surgery and endovascular surgery. Each modality has their advantages and disadvantages. The study aimed for the the early result of endovascular treatment in acute intral mural hematoma in our center. Method: We restrospective reviewed patients underwent aortic endovascular repair for IMHpatients at the University Medical Center at Ho Chi Minh City from 12/2017 to 06/2019. 1 Results: 27 patients with IMH was recorded during this time, 11 patients were treated medically and 6 patients underwent surgical or and 10 received endovascular treatment. In these 16 patients, 9 are type A IMH and 7 type B IMH. 3 type A IMHs were chosen for stent grafting. 3 patients in type B IMH group required partial debranching. No early mortality recorded, no stroke and conversion to classic dissection was seen in this group. 1 femoral artery stenosis required reconstruction. 90% of patients had total resolution of the hematoma after 6 months follow-up.


Conclusions: In our experiences with endovascular for IMH, the short term outcomes are satisfactory with no mortality and low morbidity. This treatment might be safe and feasible, bigger cohorts and long term follow-up are needed.


 

Article Details

Keywords

Intramural hematoma, acute aortic syndrome, endovascular treatment

References

1. Erbel R, Aboyans V, Boileau C, Bossone E, et al. (2014). 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 35(41):2873-926.
2. Riambau V, Bockler D, Brunkwall J, Cao P, et al. (2017). Editor's Choice - Management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 53(1):4-52.
3. Mohr-Kahaly S, Erbel R, Kearney P, Puth M, et al. (1994). Aortic intramural hemorrhage visualized by transesophageal echocardiography: findings and prognostic implications. J Am Coll Cardiol. 23(3):658-64.
4. Song JK, Kim HS, Kang DH, Lim TH, et al. (2001). Different clinical features of aortic intramural hematoma versus dissection involving the ascending aorta. J Am Coll Cardiol. 37(6):1604-10.
5. Oderich GS, Karkkainen JM, Reed NR, Tenorio ER, et al. (2019). Penetrating Aortic Ulcer and Intramural Hematoma. Cardiovasc Intervent Radiol. 42(3):321-334.
6. Evangelista A, Mukherjee D, Mehta RH, O'Gara PT, et al. (2005). Acute intramural hematoma of the aorta: a mystery in evolution. Circulation. 111(8):1063-70.
7. Eggebrecht H, Plicht B, Kahlert P, and Erbel R (2009). Intramural hematoma and penetrating ulcers: indications to endovascular treatment. Eur J Vasc Endovasc Surg. 38(6):659-65.
8. Spanos K, Kolbel T, and Giannoukas AD (2019). Current trends in aortic intramural hematoma management-a shift from conservative to a more aggressive treatment. Ann Cardiothorac Surg. 8(4):497-499.
9. Hata M, Hata H, Sezai A, Yoshitake I, et al. (2014). Optimal treatment strategy for type A acute aortic dissection with intramural hematoma. J Thorac Cardiovasc Surg. 147(1):307-11.
10. Matsushita A, Fukui T, Tabata M, Sato Y, et al. (2016). Preoperative characteristics and surgical outcomes of acute intramural hematoma involving the ascending aorta: A propensity score-matched analysis. J Thorac Cardiovasc Surg. 151(2):351-8.
11. Muetterties CE, Menon R, and Wheatley GH, 3rd (2018). A systematic review of primary endovascular repair of the ascending aorta. J Vasc Surg. 67(1):332-342. VAI TRÒ CỦA 1
2. Attia R, Young C, Fallouh HB, and Scarci M (2009). In patients with acute aortic intramural haematoma is open surgical repair superior to conservative management? Interact Cardiovasc Thorac Surg. 9(5):868-71.
13. Schmidli J, Widmer MK, Basile C, de Donato G, et al. (2018). Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 55(6):757-818.
14. Bischoff MS, Meisenbacher K, Wehrmeister M, Bockler D, et al. (2016). Treatment indications for and outcome of endovascular repair of type B intramural aortic hematoma. J Vasc Surg. 64(6):1569-1579 e2.
15. Piffaretti G, Lomazzi C, Benedetto F, Pipito N, et al. (2018). Best Medical Treatment and Selective Stent-GraftRepair for Acute Type B Aortic Intramural Hematoma. Semin Thorac Cardiovasc Surg. 30(3):279-287.
16. Lavingia KS, Ahanchi SS, Redlinger RE, Udgiri NR, et al. (2014). Aortic remodeling after thoracic endovascular aortic repair for intramural hematoma. J Vasc Surg. 60(4):929-35; discussion 935-6.
17. Ye K, Qin J, Yin M, Jiang M, et al. (2017). Acute Intramural Hematoma of the Descending Aorta Treated with Stent Graft Repair Is Associated with a Better Prognosis. J Vasc Interv Radiol. 28(10):1446-1453 e2.