Abstract 4576: Impact of Newly Appeared Ulcer-like Projection on Clinical Outcomes of Patients With Type B Aortic Intramural Hematoma
Background: Long-term clinical outcomes of patients with type B aortic intramural hematoma (IMH) with/without ulcer-like projection (ULP) has not been fully discussed. The purpose of this study was to investigate long-term outcome and impact of ULP on progression of type B IMH.
Methods: A total of 619 patients with acute aortic syndrome were admitted to our institution from 1986 to 2008. Of these patients, there were 143 patients with type B IMH. In-hospital and long-term clinical outcomes of patients with/without ULP were evaluated.
Results: Mean age of the patients was 69±11 at baseline and 55 patients were female. Mean follow-up period was 5.4 years. All patients were treated initially with medical therapy and 3 patients underwent urgent surgical repair during index hospitalization due to early complications: visceral ischemia(n=1) and lower limb ischemia(n=2). In-hospital mortality rate of all type B IMH patients was 0.7%. There were 10 late deaths including 5 cases of aortic rupture and 14 patients underwent surgical repair during follow-up period due to aortic enlargement or re-dissection. A total of 54 patients showed newly appeared ULP within 30days from the onset. The actuarial survival rate of all type B IMH patients was 98, 93 and 89% at 1, 5 and 10 years, respectively. Aorta-related event free rate of patients with ULP was significantly poorer than that of patients without ULP (p=0.007).
Conclusions: Type B IMH patients generally have favorable long-term prognosis. However, patients with ULP should be carefully followed-up with serial CT examination, since they frequently require surgical or percutaneous aortic repair during follow-up.