Acute Type B Aortic Intramural Hematoma: Treatment Strategy and the Role of Endovascular Repair

PURPOSE: To report a prospective study that explored the therapeutic strategies in the treatment of type B aortic intramural hematoma (IMH) and evaluated the role of endovascular repair. METHODS: Between January 2001 and December 2009, 56 consecutive patients were enrolled in a prospective study to evaluate stent-graft repair versus medical therapy for acute type B IMH (patients with type A IMH excluded). Patients who had penetrating atherosclerotic ulcers, maximum aortic diameter >45 mm, hematoma thickness >10 mm, or sustained chest or back pain despite maximal medical therapy received endovascular stent-grafts (n=33; mean age 60 years, range 33-86), while other patients (n=23; mean age 56 years, range 29-83) received conservative therapy. RESULTS: Stent-grafts were implanted successfully as scheduled in 33 patients as elective procedures; there were no complications related to the procedure. The mean follow-up up was 28±15 months (range 3-108). In the medically treated patients, there were 6 (26%) cases of IMH progression (4 treated with stent-grafts) and 2 (9%) deaths versus no IMH progression or death in the stent-graft patients. The thickness of the hematoma was reduced in all 37 patients receiving stent-grafts, and the maximum aortic diameter decreased in 19 of these patients. The 17 surviving patients in the medical group also showed regression of the hematoma in follow-up. CONCLUSION: Type B IMH is a potentially lethal disease, and the application of endovascular stent-grafts achieved an encouraging result in this study. Therefore, a more optimistic strategy, including endovascular repair, should be considered and evaluated in the future.