Type A Intramural Hematoma Often Turns Out To Be a Type A Dissection

2013 ◽  
Vol 16 (6) ◽  
pp. 351 ◽  
Author(s):  
Sebastian Michel ◽  
Christian Hagl ◽  
Gerd Juchem ◽  
Ralf Sodian
Keyword(s):  
Computed Tomography ◽  
Surgical Repair ◽  
False Lumen ◽  
Intramural Hematoma ◽  
Acute Chest Pain ◽  
Type A ◽  
Ascending Aorta ◽  
Descending Aorta ◽  
Type A Dissection ◽  
Thrombosed Type

<p><b>Background:</b> The management of type A intramural hematoma (IMH) is controversial. Although most Western countries still recommend immediate surgical repair, some centers in Asia have shown good results recently with medical treatment alone. Here, we present a case of type A IMH which was discovered during the operation to be a thrombosed type A dissection.</p><p><b>Case Report:</b> An 83-year-old female patient presented with acute chest pain. After diagnostic exclusion of myocardial infarction, computed tomography was performed, which showed an IMH from the ascending to the descending aorta. No intimal flap could be detected. The ascending aorta was replaced surgically with a prosthesis. During the operation, we found a ruptured intimal plaque, which had caused dissection of the aorta with thrombosis of the false lumen. The true diagnosis�thrombosed type A dissection and not IMH�was revealed neither by computed tomography nor by transesophageal echocardiography.</p><p><b>Conclusion:</b> Type A IMH should still be treated with immediate surgical repair because in many cases it turns out to be thrombosed type A dissection.</p>

Acute retrograde type A intramural hematoma treated with an endovascular approach

2018 ◽  
Vol 26 (4) ◽  
pp. 308-310 ◽  
Author(s):  
Anh T Vo ◽  
Khoi M Le ◽  
Trang T Nguyen ◽  
Thanh T Vu ◽  
Thien T Vu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intramural Hematoma ◽  
Type A ◽  
Sudden Onset ◽  
Ascending Aorta ◽  
Acute Type ◽  
Descending Aorta ◽  
Severe Chest Pain ◽  
Endovascular Approach

A 71-year-old woman was admitted with sudden onset of severe chest pain. Computed tomography demonstrated acute type A intramural hematoma with an entry tear in the first part of the descending aorta. The patient refused an operation. Endovascular repair was performed to prevent conversion to a typical dissection of the ascending aorta. At the 1-year follow-up, computed tomography showed total resolution of the intramural hematoma.

Retrograde Type A Dissection after Ascending Aorta Involved Endovascular Repair and Its Surgical Repair with Stented Elephant Trunk

2019 ◽  
Vol 58 ◽  
pp. 198-204.e1 ◽  
Author(s):  
Zhao An ◽  
Meng-Wei Tan ◽  
Zhi-Gang Song ◽  
Hao Tang ◽  
Fang-Lin Lu ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Surgical Repair ◽  
Type A ◽  
Ascending Aorta ◽  
Elephant Trunk ◽  
Type A Dissection

Thoracic Endovascular Aortic Repair for Retrograde Type A Intramural Hematoma With Intimal Disruption in the Descending Aorta

2021 ◽  
pp. 152660282110612
Author(s):  
Yingliang Wang ◽  
Songlin Song ◽  
Chen Zhou ◽  
Wenying Zhu ◽  
Jiacheng Liu ◽  
...  
Keyword(s):  
Adverse Events ◽  
Intramural Hematoma ◽  
Type A ◽  
Ascending Aorta ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Descending Aorta ◽  
Aortic Repair ◽  
Intimal Tear

Purpose: To evaluate the safety and efficacy of thoracic endovascular aortic repair (TEVAR) for retrograde type A intramural hematoma (IMH) with intimal disruption in the descending aorta and report our endovascular therapeutic experience. Materials and Methods: From January 2014 to October 2020, a total of 24 consecutive patients with retrograde type A IMH with intimal disruption (intimal tear or ulcer-like projection) in the descending aorta underwent TEVAR. The demographics, clinical characteristics, treatment details, imaging information, and follow-up results were reviewed. Results: Among all patients with retrograde type A IMH, 13 (54.2%) patients presented with ulcer-like projection and 11 (45.8%) with intimal tear (aortic dissection) in the descending aorta. Successful TEVAR was achieved in all patients. There was no 30-day mortality. During a mean follow-up of 37.5 months, 1 patient (4.2%) developed permanent paralysis, 1 patient (4.2%) underwent reintervention due to the expansion of the aorta distal to the stent resulting from the enlargement of distal intimal tear at the 2 month follow up, and no other adverse events were observed. The latest computed tomographic angiography images showed that the maximum diameter of the ascending aorta and descending aorta significantly decreased after TEVAR (both p<0.001), and the IMH/false lumen in the ascending aorta and the descending thoracic aorta were completely absorbed. Conclusion: Thoracic endovascular aortic repair for selected patients with retrograde type A intramural hematoma that presented with intimal disruption in the descending aorta is feasible and efficient, but close surveillance is needed to manage aortic-related adverse events.

Initial medical management in acute type A aortic dissection patients with a thrombosed false lumen in the ascending aorta combining intramural hematoma and retrograde dissection from the descending to the ascending aorta

2018 ◽  
Vol 9 (3_suppl) ◽  
pp. S13-S20 ◽  
Author(s):  
Kenji Sadamatsu ◽  
Susumu Takase ◽  
Shuichiro Sagara ◽  
Kensuke Ohe ◽  
Jun-ichiro Nishi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Medical Management ◽  
False Lumen ◽  
Intramural Hematoma ◽  
Type A ◽  
Daily Practice ◽  
Ascending Aorta ◽  
Maximum Diameter ◽  
Acute Type ◽  
Type A Aortic Dissection

Background: The feasibility of medical management for select patients with acute type A aortic dissection has been reported from a few institutions. In this study, we retrospectively investigated the safety and feasibility of our conservative approach for patients with type A aortic dissection in daily practice. Methods: From January 2013 to December 2017, 131 consecutive patients were admitted to our institution for acute aortic dissection, including 58 patients of type A. Initial medical management was attempted in select patients who were clinically stable and had a thrombosed false lumen of the ascending aorta without ulcer-like projections in the ascending aorta. Results: Except for nine patients contraindicated for surgery, urgent surgery was performed in 26 patients (SRG group), while 23 patients (MED group) were treated with the initial medical management. The maximum diameter of the ascending aorta was significantly larger in the SRG group than in the MED group. In the MED group, the heart rate and blood pressures were well-controlled at admission to the intensive-care unit, and the systolic blood pressure was further reduced at 24 h after. The in-hospital mortality rates of the MED and SRG groups were 0% and 15%, respectively. During the follow-up period, the survival rate was significantly higher in the MED group than in the SRG group, and the aortic event-free survival at one year was 80%. Conclusions: The initial medical management for select patients with a thrombosed false lumen in the ascending aorta was a safe and feasible strategy in real-world practice.

scholarly journals Surgical repair of Stanford type A acute aortic dissection with extreme tuberculosis-related mediastinal deviation

2019 ◽  
Vol 29 (5) ◽  
pp. 800-802
Author(s):  
Hiroyuki Saisho ◽  
Satoru Tobinaga ◽  
Shohei Yoshida ◽  
Hiroyuki Tanaka
Keyword(s):  
Computed Tomography ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Surgical Repair ◽  
Type A ◽  
Ascending Aorta ◽  
Postoperative Course ◽  
X Ray ◽  
History Of ◽  
Chest X Ray

Abstract In this article, we report on the case of an 85-year-old woman with a history of left pulmonary tuberculosis, who was referred for Stanford type A acute aortic dissection. A preoperative chest X-ray and computed tomography revealed extreme mediastinal deviation to the left. We decided to perform surgery with left rib-cross thoracotomy. This approach yielded excellent exposure of the aortic root, ascending aorta and aortic arch. Following an uneventful operative and postoperative course, the patient was discharged on the 21st postoperative day.

scholarly journals Use of ASD closure device for the sealing of false lumen entry in the ascending aorta after dissection Type A surgical repair

2021 ◽  
Vol 14 (8) ◽  
pp. e242304
Author(s):  
Ivo Spasov Petrov ◽  
Zoran Iovan Stankov ◽  
Damyan Boychev Boychev
Keyword(s):  
False Lumen ◽  
Type A ◽  
Ascending Aorta ◽  
Closure Device ◽  
Atrial Septal Defect Closure ◽  
Aorta Replacement ◽  
Type A Dissection ◽  
Asd Closure ◽  
Ascending Aorta Replacement

We present a case of a persistent false lumen after ascending aorta replacement due to Stanford Type A dissection treated by endovascular means. The main entry tear was occluded with an atrial septal defect closure device, sealing the false lumen. A total of five additional stents were implanted to centralise and secure the flow in the true lumen. CT scan at 6-month follow-up showed excellent results with a decreased total aortic diameter and thrombosed false lumen.

Cannulating a Dissecting Aorta Using Ultrasound-Epiaortic and Transesophageal Guidance

2011 ◽  
Vol 14 (6) ◽  
pp. 373 ◽  
Author(s):  
Saina Attaran ◽  
Maria Safar ◽  
Hesham Zayed Saleh ◽  
Mark Field ◽  
Manoj Kuduvalli ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Ascending Aorta ◽  
Type A Aortic Dissection ◽  
Complete Rupture

<p>Management of acute Stanford type A aortic dissection remains a major surgical challenge. Directly cannulating the ascending aorta provides a rapid establishment of cardiopulmonary bypass but consists of risks such as complete rupture of the aorta, false lumen cannulation, subsequent malperfusion and propagation of the dissection.</p><p>We describe a technique of cannulating the ascending aorta in patients with acute aortic dissection that can be performed rapidly in hemodynamically unstable patients under ultrasound-epiaortic and transesophageal (TEE) guidance.</p>

Emergent Triple-Branched TEVAR and Redistribution of the Branches to the Supra-Aortic Target Vessels for Treatment of a Contained Ruptured Descending Aortic Aneurysm Associated With a Chronic Type A Aortic Dissection

2021 ◽  
pp. 152660282098527
Author(s):  
Jan Stana ◽  
Carlota Fernandes Prendes ◽  
Ramin Banafsche ◽  
Nikolaos Konstantinou ◽  
Barbara Rantner ◽  
...  
Keyword(s):  
False Lumen ◽  
Type A ◽  
Emergency Setting ◽  
Chronic Type ◽  
Type A Aortic Dissection ◽  
Custom Made ◽  
Descending Aortic Aneurysm ◽  
Type A Dissection ◽  
Open Surgical Approach

Purpose: To demonstrate the feasibility of urgent endovascular treatment of a chronic type A dissection and contained rupture of the false lumen using a noncustomized triple-branched arch endograft, which necessitated reassignment of the branches to the supra-aortic vessels. Case Report:: A 57-year-old patient with a contained rupture of the descending thoracic aorta, in the setting of a chronic type A dissection and a maximum aortic diameter of 85 mm, was converted to endovascular repair after failure of an open surgical approach. A custom-made triple-branched arch endograft designed for another patient was employed, with concomitant occlusion of the false lumen using a Candy Plug occluder. To adjust the graft’s configuration to the patient’s anatomy, the supra-aortic vessels were not assigned to the originally planned branches. The 12-month follow-up angiography demonstrated a satisfactory result. Conclusion: A noncustomized triple-branched arch endograft can be used in an emergency setting to treat chronic type A dissection, reassigning the branches to the supra-aortic vessels as needed.

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