Intramural hematoma of the descending aorta-natural history and treatment

Kevin M. Harris, Jip L. Tolenaar, Kim A. Eagle, Santi Trimarchi

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Aortic Intramural hematoma (IMH) represents a subtype of aortic dissection characterized by crescentic thickening of the aortic wall and the absence of an intimal flap or visualized entry point. The diagnosis is typically established by imaging techniques such as CT or MRI and the prevalence varies widely per published series between 5 and 48 % of all acute aortic syndromes. Patients with IMH share the same risk profile as those with typical aortic dissection though tend to be of older age. The symptoms are also similar to acute aortic dissection, including acute chest and back pain. Mortality for IMH in a large meta-analysis was 14 %, regardless of management. The majority of patients are treated with an initial medical approach, which is successful in the vast majority of patients. Certain patient groups may be at increased risk for progression to typical aortic dissection or rupture. Risks for progression of IMH include greater size of the aorta (i.e., 5 cm), presence of penetrating ulcers, Marfan syndrome, absence of beta-blockade, pleural effusions and persistent pain. Open surgical repair is utilized infrequently in type B IMH and reserved for complicated cases. In the current era, endovascular stent grafting would be the treatment of choice for symptomatic patients. Care should be taken to cover all potential areas of intimal communication by the stent graft.

Original languageEnglish
Title of host publicationControversies in Aortic Dissection and Aneurysmal Disease
PublisherSpringer-Verlag London Ltd
Pages397-411
Number of pages15
ISBN (Print)9781447156222, 1447156218, 9781447156215
DOIs
Publication statusPublished - Jan 1 2014

Fingerprint

Natural History
Thoracic Aorta
Hematoma
Dissection
Tunica Intima
Stents
Therapeutics
Marfan Syndrome
Acute Pain
Pleural Effusion
Back Pain
Chest Pain
Ulcer
Aorta
Meta-Analysis
Rupture
Communication
Transplants
Pain
Mortality

Keywords

  • Aortic dissection
  • Aortic intramural hematoma
  • Diagnosis
  • Stent graft
  • Surgery

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Harris, K. M., Tolenaar, J. L., Eagle, K. A., & Trimarchi, S. (2014). Intramural hematoma of the descending aorta-natural history and treatment. In Controversies in Aortic Dissection and Aneurysmal Disease (pp. 397-411). Springer-Verlag London Ltd. https://doi.org/10.1007/978-1-4471-5622-2_35

Intramural hematoma of the descending aorta-natural history and treatment. / Harris, Kevin M.; Tolenaar, Jip L.; Eagle, Kim A.; Trimarchi, Santi.

Controversies in Aortic Dissection and Aneurysmal Disease. Springer-Verlag London Ltd, 2014. p. 397-411.

Research output: Chapter in Book/Report/Conference proceedingChapter

Harris, KM, Tolenaar, JL, Eagle, KA & Trimarchi, S 2014, Intramural hematoma of the descending aorta-natural history and treatment. in Controversies in Aortic Dissection and Aneurysmal Disease. Springer-Verlag London Ltd, pp. 397-411. https://doi.org/10.1007/978-1-4471-5622-2_35
Harris KM, Tolenaar JL, Eagle KA, Trimarchi S. Intramural hematoma of the descending aorta-natural history and treatment. In Controversies in Aortic Dissection and Aneurysmal Disease. Springer-Verlag London Ltd. 2014. p. 397-411 https://doi.org/10.1007/978-1-4471-5622-2_35
Harris, Kevin M. ; Tolenaar, Jip L. ; Eagle, Kim A. ; Trimarchi, Santi. / Intramural hematoma of the descending aorta-natural history and treatment. Controversies in Aortic Dissection and Aneurysmal Disease. Springer-Verlag London Ltd, 2014. pp. 397-411
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