Successful one‐stage operation for type B acute intramural hematoma with descending aortic rupture

Introduction: Although acute type B aortic intramural hematoma (B-IMH) is a variant of acute aortic syndrome having similar clinical demographics to type B classic aortic dissection (B-AD), early clinical course including acute complications are not well investigated. The purpose of this study was to investigate early clinical course and acute complications of B-IMH in comparison with that of B-AD. Methods: Clinical features and early clinical course including acute complications were retrospectively analyzed in 270 B-IMH and 177 B-AD consecutive patients who were admitted to our hospital between 1991 and 2020. Acute complications were defined as rupture, impending rupture, re-dissection, and visceral and leg ischemia. Results: As compared with B-AD, B-IMH presented at older age (72±11 vs 62±15 years; p<0.001), predominantly in females (37% vs 25%). During in-hospital courses, limb ischemia and mesenteric ischemia were less common in patients with B-IMH than those with B-AD (0.4% versus 5.1%, p=0.003, 0.4% versus 2.8%, p=0.03; respectively). In contrast, spinal ischemia was more common in B-IMH patients (2.4% versus 0.6%, p=0.05). Aortic rupture and impending rupture were comparable between B-IMH and B-AD patients (5.9% versus 7.3%. p=0.28). Besides, re-dissection was also comparable between two groups (2.2% versus 5.1%, p=0.06). As a result, prevalence of acute complications was significantly lower in patients with B-IMH (8.8% versus 17%, p=0.008). In-hospital mortality rate in B-IMH was significantly lower than that in B-AD (0.4% versus 9.0%, p<0.001). Conclusions: Although patients with B-IMH had lower in-hospital mortality rates than patients with B-AD, significant portion of B-IMH patients had fatal complications including spinal ischemia or aortic rupture. Patients with B-IMH should be carefully observed as well as patients with B-AD patients.

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IMPACT OF THORACIC ENDOVASCULAR AORTIC REPAIR TIMING ON AORTIC REMODELING IN ACUTE TYPE B AORTIC INTRAMURAL HEMATOMA

Journal of Vascular Surgery ◽

10.1016/j.jvs.2021.08.059 ◽

2021 ◽

Author(s):

Tomaz Mesar ◽

Fanny S. Alie-Cusson ◽

Maggie J. Lin ◽

David J. Dexter ◽

Animesh Rathore ◽

...

Keyword(s):

Intramural Hematoma ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Acute Type ◽

Type B ◽

Aortic Repair ◽

Aortic Intramural Hematoma ◽

Aortic Remodeling

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Analysis of predictive factors for progression of type B aortic intramural hematoma with computed tomography

Journal of Vascular Surgery ◽

10.1067/mva.2002.123683 ◽

2002 ◽

Vol 35 (6) ◽

pp. 1179-1183 ◽

Cited By ~ 67

Author(s):

Eijun Sueyoshi ◽

Tatsuya Imada ◽

Ichiro Sakamoto ◽

Yohjiro Matsuoka ◽

Kuniaki Hayashi

Keyword(s):

Computed Tomography ◽

Predictive Factors ◽

Intramural Hematoma ◽

Type B ◽

Aortic Intramural Hematoma

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Type A Intramural Hematoma in the Setting of Acute Type B Aortic Dissection

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2013.01.096 ◽

2013 ◽

Vol 96 (5) ◽

pp. 1868-1870

Author(s):

Christina M. Vassileva ◽

Blaine T. Manning ◽

Theresa M. Boley ◽

Stephen R. Hazelrigg

Keyword(s):

Aortic Dissection ◽

Intramural Hematoma ◽

Type A ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection

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Primary Mediastinal Undifferentiated Carcinoma Mimicking Type B Aortic Intramural Hematoma

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2017.04.061 ◽

2017 ◽

Vol 104 (3) ◽

pp. e283

Author(s):

Qiang Zhu ◽

Wen-cheng Che ◽

Wei Wang ◽

Tian-chang Zhen ◽

Gong-zhang Su ◽

...

Keyword(s):

Intramural Hematoma ◽

Undifferentiated Carcinoma ◽

Type B ◽

Aortic Intramural Hematoma

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Conservatively treated Type B intramural hematoma: Progression into acute aortic dissection followed by spontaneous resolution, assessed by CT

Radiology Case Reports ◽

10.2484/rcr.v9i2.929 ◽

2014 ◽

Vol 9 (2) ◽

pp. 929

Author(s):

Guadalupe Buitrago ◽

Sabina Vasaturo ◽

Lucia J.M. Kroft

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Intramural Hematoma ◽

Spontaneous Resolution ◽

Type B

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Abstract 2680: Tight Heart Rate Control Reduces Secondary Adverse Events in Patients with Type B Acute Aortic Dissection

Circulation ◽

10.1161/circ.116.suppl_16.ii_594-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Kazuhisa Kodama ◽

Kazuhiro Nishigami ◽

Tadashi Sawamura ◽

Koichi Nakao ◽

Takashi Honda

Keyword(s):

Heart Rate ◽

Aortic Dissection ◽

Medical Treatment ◽

Rate Control ◽

Aortic Rupture ◽

Aortic Surgery ◽

Control Group ◽

Type B ◽

Heart Rate Control ◽

Arterial Blood

Background : Although type B aortic dissection (AD) has been treated with beta-blocker to lower the arterial blood pressure (BP), there has been little evidences about reduction in heart rate (HR). We assessed whether tight HR control improved the outcome of medical treatment in patients with AD. Methods and Results : From 1997 to 2005, consecutive 223 patients with AD medically treated and controlled to lower BP under 120 mmHg were enrolled. Based on the average HR at 3, 5, and 7 days after the onset, patients were divided to tight HR (<60 bpm) control group (39 patients; mean HR of 56 .8bpm) and conventional HR (equal or more than 60 bpm) control group (184 patients; mean HR of 71.6 bpm). We compared the frequency of aortic events including aortic rupture, recurrent dissection, and aortic expansion of more than 5mm, and surgical requirement between two groups. During a median follow-up of 33.3 months, aortic rupture, recurrent dissection, pathological aortic expansion, and aortic surgery occurred in 3, 14, 43, and 30 patients respectively. Reductions in aortic events and surgical requirement were observed in tight HR control group (10.3% and 2.6%) compared to conventional HR control group (28.3% and 15.8%) (Odds ratio: 0.29 and 0.14. C.I.:0.10 to 0.90 and 0.02 to 1.07, p<0.01.). Kaplan-Meier curves of aortic event and surgical requirement free rates were shown in figure 1 and 2 . Conclusions : The present study demonstrated that tight heart rate control improved the outcome of medical treatment in patients with AD.

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Pregnancy in a woman with a chronic descending thoracic aortic dissection

Obstetric Medicine ◽

10.1177/1753495x19900410 ◽

2020 ◽

pp. 1753495X1990041

Author(s):

Govind Krishna Kumar Nair ◽

Catriona Bhagra ◽

Mathew Sermer ◽

Candice K Silversides ◽

Birgit Pfaller

Keyword(s):

Aortic Dissection ◽

Aortic Wall ◽

Aortic Rupture ◽

Balloon Dilation ◽

Wall Stress ◽

Type B ◽

Type B Aortic Dissection ◽

Chronic Type ◽

Planned Pregnancy ◽

History Of

Pregnancy increases aortic wall stress and, for a woman with a chronic dissection, this can lead to extension of the dissection, aortic rupture, and death. We report a pregnancy in a woman with a history of a chronic type B aortic dissection. As a child, she had repeat balloon dilation of aortic coarctation, and one of the procedures was complicated by an iatrogenic dissection at the dilation site. At the age of 27 years, she had a planned pregnancy.

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