Background-Acute aortic intramural hematoma (IMH) is an important subgroup of aortic dissection, and controversy surrounds appropriate management. Methods and Results-Patients with acute aortic syndromes in the International Registry of Acute Aortic Dissection (1996-2011) were evaluated to examine differences between patients (based on the initial imaging test) with IMH or classic dissection (AD). Of 2830 patients, 178 had IMH (64 type A [42%], 90 type B [58%], and 24 arch). Patients with IMH were older and presented with similar symptoms, such as severe pain. Patients with type A IMH were less likely to present with aortic regurgitation or pulse deficits and were more likely to have periaortic hematoma and pericardial effusion. Although type A IMH and AD were managed medically infrequently, type B IMH were more frequently treated medically. Overall in-hospital mortality was not statistically different for type A IMH compared to AD (26.6% versus 26.5%; P=0.998); type A IMH managed medically had significant mortality (40.0%), although less than classic AD (61.8%; P=0.195). Patients with type B IMH had a hospital mortality that was less but did not differ significantly (4.4% versus 11.1%; P=0.062) from classic AD. One-year mortality was not significantly different between AD and IMH. Conclusions-Acute IMH has similar presentation to classic AD but is more frequently complicated with pericardial effusions and periaortic hematoma. Patients with IMH have a mortality that does not differ statistically from those with classic AD. A small subgroup of type A IMH patients are managed medically and have a significant in-hospital mortality.
|Titolo:||Acute aortic intramural hematoma : an analysis from the international registry of acute aortic dissection|
|Parole Chiave:||aortic dissection; aortic intramural hematoma; aortic surgery; diagnosis; imaging; Acute Disease; Age Factors; Aged; Aged, 80 and over; Aneurysm, Dissecting; Aortic Aneurysm; Aortic Valve Insufficiency; Comorbidity; Disease Management; Female; Global Health; Hematoma; Hospital Mortality; Humans; Male; Middle Aged; Pain; Pericardial Effusion; Prognosis; Pulse; Registries; Retrospective Studies; Treatment Outcome; Physiology (medical); Cardiology and Cardiovascular Medicine|
|Settore Scientifico Disciplinare:||Settore MED/22 - Chirurgia Vascolare|
|Data di pubblicazione:||set-2012|
|Digital Object Identifier (DOI):||10.1161/CIRCULATIONAHA.111.084541|
|Appare nelle tipologie:||01 - Articolo su periodico|