Abstract 4577: Medically Treated Patients With Acute Type A Intramural Hematoma of the Aorta: How They Should be Managed in the Long-term Period?
Objectives: Controversy exists in the optimal treatment for acute type A aortic intramural hematoma. The aim of this study was to evaluate the efficacy of our decision-making algorithm for the long-term results of the patients with type A intramural hematoma.
Methods: Our decision-making algorithm consisted of 2 steps. Step 1: Patients with the maximum diameter of the ascending aorta larger than 50mm and/or ulcer-like projection at the initial presentation undergo urgent surgery. Other patients receive medical treatment with intense blood pressure control (systemic blood pressure <120mmHg) and periodic follow-up CT imaging. Step 2: During the follow-up period of medically treated patients, patients with ascending aorta dilatation more than 50mm, new ulcer-like projection or progression to aortic dissection undergo scheduled surgery. Since 1991 through 2008, 67 patients with acute type A aortic intramural hematoma were treated. They were 34 male and 33 female patients with the mean age of 67.5±10.5 (range, 48–86 years). Long-term follow-up was 100% complete.
Results: Among 67 patients with type A intramural hematoma, 38 patients (57%) were medically treated at the initial presentation. During follow-up period, 14 patients (37% of the medically-treated patients) underwent scheduled ascending aorta replacement, associated with nos hospital death. The mean time of the surgery after the initial presentation was 156th day (range, the 3rd–1440th day). Among medically treated patients, vascular related death occurred in 2 patients (rupture of the abdominal aorta, acute intestinal ischemia). Follow-up study of medically treated patients showed the freedom from vascular related events (except for ascending aorta replacement) was 95%, 84%, 80% and 80% at 1, 3, 5 and 10 years. The freedom from vascular related death was 100%, 96%, 92% and 92% at 1, 3, 5 and 10 years.
Conclusions: Selected patients with acute type A aortic intramural hematoma can be treated medically at the initial presentation, followed by intense blood pressure control, periodic CT imaging and appropriate surgery, with excellent long-term results.