Thorac Cardiovasc Surg 2011; 59(6): 342-348
DOI: 10.1055/s-0030-1270761
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Early Aggressive Medical Treatment Associated with Selective Prophylactic Aortic Stent-Grafting for Aortic Intramural Hematoma

G. Zhang1 , Q. Feng1 , D. Zheng1 , L. Ma1 , R. Li1 , J. Jiang2 , Y. Ni1
  • 1Department of Cardiovascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
  • 2Department of Emergency, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
Further Information

Publication History

received Nov. 20, 2010

Publication Date:
22 March 2011 (online)

Abstract

Background: Although recent studies suggest that medical treatment is appropriate for patients with aortic intramural hematoma (IMH), the outcomes of supportive medical treatment alone have not been satisfactory, and clear guidelines for medical treatment are not yet available. We assessed whether a management protocol of combined early aggressive medical treatment and selective prophylactic aortic stent-grafting would benefit patients with IMH. Methods: Nineteen patients with IMH were prospectively studied; after initial clinical and radiological evaluation, 13 underwent early aggressive medical therapy (group 1), and 6 underwent early aggressive medical therapy and prophylactic endovascular stent-grafting (group 2). Results: In group 1, one patient with type A IMH died prior to surgical consultation because of cardiac tamponade; another patient with type A IMH underwent replacement of the ascending aorta at the 6-month follow-up. The condition of the other 11 patients stabilized during hospitalization and after discharge. The disease spontaneously regressed in 10 patients, and the intramural hematoma completely resolved in 5 patients. In group 2, follow-up imaging revealed complete coverage of the penetrating aortic ulcers and regression of the intramural hematoma; endovascular leaks have not yet occurred. Conclusions: Our protocol may be used as an alternative approach for patients with IMH. After initial clinical and radiological evaluation, the condition of patients without complications can be stabilized with medical treatment; frequent follow-up imaging is required in such cases. Early aggressive medical treatment combined with prophylactic aortic stent-grafting is a safe and effective treatment modality for IMH patients with penetrating aortic ulcers in the descending aorta.

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Prof. Yiming Ni, MD

Department of Cardiovascular Surgery
The First Affiliated Hospital, College of Medicine,Zhejiang University

# 79 Qingchun Road

310003 Hangzhou

China

Phone: +86 1 38 05 73 27 99

Fax: +86 5 71 87 23 68 43

Email: zycszju@yahoo.com

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