Abstract 17170: Acute Aortic Intramural Hematoma: an Analysis from the International Registry of Acute Aortic Dissection
Background: Acute aortic intramural hematoma (IMH) represents an important subgroup of aortic dissection though controversy continues to surround the appropriate management.
Methods: We evaluated patients with acute aortic syndromes in the IRAD registry (between 1996 and 2011) and examined differences between patients (based on the initial imaging test) with IMH or classic dissection (AD).
Results: Of 2908 patients, 182 had IMH (72 type A (TA), 39.6%, 110 type B (TB), 60.4%). Patients with IMH were older in both TA (68.9 years vs. 61.4, p<0.001) and TB (69.3 vs 62.7, p<0.001), and more frequently female in TA (44.4% vs 32.3%, p=.031). Patients presented with similar symptoms such as severe pain in TA (98.4% vs 91.6%, p=NS) and TB (95.7% vs 93.0%, p=NS). Patients with TA IMH were less likely to present with aortic regurgitation (37.3% vs 54.8%, p=.008) or pulse deficits (16.7% vs31.5%, p=.015). Patients with TA IMH were more likely to have periaortic hematoma (47.5% vs 19.9%, p<0.001) and pericardial effusion (60.0% vs 41.2%, p=.002). Patients with IMH were more likely than classic AD to be managed medically (TA, 22.2% vs 12.6%, p=.017, type B 85.5% vs 62.9%, p<0.001). Overall in-hospital mortality was similar for type A IMH (26.4% vs 26.4%, p=NS); those with type A IMH managed medically had significant mortality (37.5%) though less than those with classic AD (58.5%, p=NS). Those with type B IMH had lower in hospital mortality (4.5% vs 10.9%, p=.043) than classic AD. One year mortality was similar for both groups.
Conclusion: The IRAD registry includes 182 cases of IMH and represents the largest series to date on this important variant of AD. Acute IMH has similar presentation to classic AD but is more frequently complicated with pericardial effusions and periaortic hematoma. Patients with IMH have similar mortality to those with classic AD. Although a substantial subgroup of type A patients with IMH are managed medically, they do have a significant hospital mortality.
- © 2011 by American Heart Association, Inc.