Clinical characteristics and prognostic value of focal enhancement on computed tomography angiography in patients with acute type B aortic intramural hematoma / 中华普通外科杂志

ABSTRACT

Objective To summarize the clinical experience on acute type B aortic intramural hematoma,and to investigate the relation between focal enhancement characteristics on CT angiography (CTA) and the outcome of acute type B aortic intramural hematoma.Methods From Sep 2009 to Mar 2017,a total of 29 patients with acute type B aortic intramural hematoma treated in our department were retrospectively reviewed.After type B aortic intramural hematoma diagnosis by CTA,patients were prescribed anti-hypertension medicine with targeted systolic blood pressure of less than 120 mmHg.Then patients underwent a schemed CT angiography review within 2 weeks if no complications occurred.Surgical indications included recurrent pain,enlarged extent of hematoma and appearance of penetrated ulcer/dissection/aneurysm,and hematoma around the aorta or rupture.Results In the initial CT imagines,lesions of intimal defect were found in 22 patients,intramural blood pool in 16 patients,and ulcer-like projection in 16 patients.15 patients underwent thoracic endovascular aortic repair,with success rate of 100％,no mortality.The median duration of follow-up was 28 months.There was no aortic related complications nor death.Among the 14 patients treated by medicine 1 patient had formation of dissection and 1 patient with new-onset penetrating ulcer lesion and formation of thoracic aortic aneurysm.These two received thoracic endovascular aortic repair successfully.The proportion of deterioration of intramural hematoma in patients with ulcer-like projection lesions in initial CT imagines was higher than that in patients without ulcer-like projection lesions (7％ vs.33％,P =0.047).The proportion of deterioration of intramural hematoma in patients with intimal defect and intramural blood pool lesions in initial CT imagines was 68％ and 69％,respectively.Conclusions Strict anti-hypertension medical treatment with timely surgical repair was effective for acute type B intramural hematoma of the aorta.Intramural hematoma with ulcer-like projection lesions are prone to deterioration.