Initial Medical Stabilization Followed by Endovascular Repair Leads to Optimal Midterm Outcome for Treatment of Aortic Arch Pathologies Associated With Retrograde Type a Intramural Hematoma

Complicated Type A intramural hematoma involving the arcus aorta requires emergency correction of the aortic arch. Surgical options include reimplantation of the brachiocephalic vessels as an island to a vascular graft, debranching aortic arch surgery, and Kazui technique. This report describes a modified technique for aortic arch repair in a patient with vascular diameter mismatch between the ascending and descending aorta, as well as an intimal tear between the brachiocephalic vessels.

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Retrograde Type A Dissection After Endovascular Repair of a “zone 0” Nondissecting Aortic Arch Aneurysm

Annals of Vascular Surgery ◽

10.1016/j.avsg.2010.02.045 ◽

2010 ◽

Vol 24 (7) ◽

pp. 952.e1-952.e7 ◽

Cited By ~ 15

Author(s):

Yamume Tshomba ◽

Luca Bertoglio ◽

Enrico Maria Marone ◽

Davide Logaldo ◽

Francesco Maisano ◽

...

Keyword(s):

Aortic Arch ◽

Endovascular Repair ◽

Type A ◽

Aortic Arch Aneurysm ◽

Type A Dissection ◽

Arch Aneurysm

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CONSERVATIVE TREATMENT AS A THERAPEUTIC OPTION FOR PENETRATING AORTIC ULCER OF THE AORTIC ARCH IN A PATIENT WITH BICUSPID AORTIC VALVE

Wiadomości Lekarskie ◽

10.36740/wlek202007148 ◽

2020 ◽

Vol 73 (7) ◽

pp. 1580-1582

Author(s):

Olga Możeńska ◽

Michał Wojewódzki ◽

Diana Wiligórska ◽

Natalia Wiligórska ◽

Robert J. Gil ◽

...

Keyword(s):

Aortic Valve ◽

Conservative Treatment ◽

Aortic Arch ◽

Bicuspid Aortic Valve ◽

Therapeutic Option ◽

Intramural Hematoma ◽

Type A ◽

Penetrating Aortic Ulcer ◽

Asymptomatic Patients ◽

Acute Aortic Syndromes

Penetrating aortic ulcer (PAU) is ulceration of an aortic atherosclerotic plaque penetrating through the internal lamina into the media. PAU is a rare condition and occurs in 2% – 7% of acute aortic syndromes (AAS); however, the actual incidence is unknown because of asymptomatic patients. One may treat it conservatively as well as surgically. We present a case of a 54-year-old man, who was admitted to hospital due to the exaggeration of exertional chest pain and persistent headaches. During coronary angiography, the suspicion of PAU was raised. Contrast-enhanced computed tomography confirmed the diagnosis. Transesophageal echocardiography showed bicuspid aortic valve with minimal calcification, the dilated ascending aorta, large atherosclerotic plaques in the aortic arch with ulceration (thickness: 5.0 – 5.5mm, diameter: 5 – 6 mm, depth: 3 – 4 mm), without intramural hematoma. Conservative treatment was chosen with uneventful 2-year follow-up. Although surgical management is advocated for patients with PAU type A, we demonstrated that type A PAU can be successfully treated conservatively as well.

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Percutaneous endovascular repair of acute type A intramural hematoma of the ascending aorta

ASVIDE ◽

10.21037/asvide.2019.284 ◽

2019 ◽

Vol 6 ◽

pp. 284-284

Author(s):

Ali Khoynezhad

Keyword(s):

Endovascular Repair ◽

Intramural Hematoma ◽

Type A ◽

Ascending Aorta ◽

Acute Type

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Endovascular repair of aortic arch intramural hematoma and penetrating ulcers with 810 nm in situ laser-assisted fenestration: Preliminary results of a single-center

Lasers in Surgery and Medicine ◽

10.1002/lsm.22937 ◽

2018 ◽

Vol 50 (8) ◽

pp. 837-843 ◽

Cited By ~ 5

Author(s):

Guang Liu ◽

Jinbao Qin ◽

Chaoyi Cui ◽

Zhen Zhao ◽

Kaichuang Ye ◽

...

Keyword(s):

Aortic Arch ◽

Endovascular Repair ◽

Intramural Hematoma ◽

Single Center ◽

Preliminary Results

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Thoracic endovascular repair of a rare case of leaking aortic arch intramural hematoma secondary to Giant cell arteritis

CVIR Endovascular ◽

10.1186/s42155-019-0052-6 ◽

2019 ◽

Vol 2 (1) ◽

Cited By ~ 1

Author(s):

Abhijit Salaskar ◽

Farzad Najam ◽

Elizabeth Pocock ◽

Shawn Sarin

Keyword(s):

Giant Cell Arteritis ◽

Aortic Arch ◽

Giant Cell ◽

Endovascular Repair ◽

Intramural Hematoma ◽

Aortic Aneurysms ◽

Active Extravasation ◽

History Of ◽

One Year ◽

Aortic Intramural Hematoma

Abstract Background Traditionally thoracic aortic aneurysms (TAA) secondary to Giant Cell Arteritis (GCA) were treated with resection and open repair. However no prior studies have reported an aortic intramural hematoma (IMH) as a presentation of GCA or outcome of thoracic endovascular aortic repair (TEVAR) in TAA or IMH secondary to GCA. Case presentation A 59 year old female, nonsmoker, non-hypertensive, non-diabetic with a known history of GCA, temporal arteritis on prednisone presented with shortness of breath & chest pain. Chest CT revealed aortic arch IMH and large left hemothorax. CTA confirmed distal aortic arch focal dilation, a focal intimal irregularity in the distal aortic arch and extensive IMH without any active extravasation or signs of aortitis. Patient underwent an urgent TEVAR without oversizing the aortic landing zones. Post TEVAR aortogram showed exclusion of the site of IMH origin and dilated aortic arch segment by the stent and absence of active extravasation. One month post-TEVAR CTA showed patent stent graft with resolution of IMH and hemothorax. One year after TEVAR, patient remained asymptomatic. Conclusion GCA can present as an IMH secondary to underlying chronic vasculitis. When endovascular repair is considered, great care should be taken not to grossly oversize aortic landing zones.

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