The treatment of calcified type B aortic intramural hematoma / 介入放射学杂志

ABSTRACT

Objective To investigate the suitable therapeutic schedule for Stanford B aortic intramural hematoma associated with calcification. Methods During the period from March 2009 to March 2012, a total of 15 patients of Stanford B aortic intramural hematoma with calcified plaque were admitted to authors’ hospital. The diagnosis was proved in all patients by CT angiography of the entire aorta with a 64-row CT scanner. Of the 15 patients, death occurred in one, thoracic endovascular aortic repair (TEVAR) treatment was adopted in 7 and conservative therapy was carried out in 7. All the patients were followed up for one year. CT angiography was employed at 3, 6 and 12 months after the treatment to evaluate the therapeutic results. Results One patient died of acute myocardial infarction after admission to hospital when the long-tem use of antiplatelet drugs was stopped. Seven patients received TEVAR treatment and the remaining 7 patients were treated with strict conservative therapy, and all these patients were asymptomatic at the time of discharge. During the follow- up period, CT angiography performed at 3, 6 and 12 months after the treatment showed that the intramural hematoma lesions gradually shrank or were absorbed in 13 patients, and the patients were asymptomatic. The remaining one patient was lost in touch. Conclusion The key to treat Stanford B aortic intramural hematoma with calcification is to prevent deterioration of the lesion. While strict conservative treatment is kept on, TEVAR should be promptly carried out for patients who need to take antiplatelet drugs over a long period of time, for patients whose clinical symptoms are not improved, for patients in whom the relived symptoms recur, and for patients whose CT angiography shows that the penetrating aortic ulcer becomes worse.