Original Article
Clinical characteristics and prognostic value of focal enhancement on computed tomography angiography in patients with acute type B aortic intramural hematoma
Weihao Li, Yang Yang, Tao Zhang, Wei Li, Xuemin Zhang, Qingle Li, Xiaoming Zhang
Published 2018-06-25
Cite as Chin J Gen Surg, 2018, 33(6): 473-477. DOI: 10.3760/cma.j.issn.1007-631X.2018.06.010
Abstract
ObjectiveTo summarize the clinical experience on acute type B aortic intramural hematoma, and to investigate the relation between focal enhancement characteristics on CT angiography(CTA) and the outcome of acute type B aortic intramural hematoma.
MethodsFrom Sep 2009 to Mar 2017, a total of 29 patients with acute type B aortic intramural hematoma treated in our department were retrospectively reviewed.After type B aortic intramural hematoma diagnosis by CTA, patients were prescribed anti-hypertension medicine with targeted systolic blood pressure of less than 120 mmHg. Then patients underwent a schemed CT angiography review within 2 weeks if no complications occurred. Surgical indications included recurrent pain, enlarged extent of hematoma and appearance of penetrated ulcer/dissection/aneurysm, and hematoma around the aorta or rupture.
ResultsIn the initial CT imagines, lesions of intimal defect were found in 22 patients, intramural blood pool in 16 patients, and ulcer-like projection in 16 patients. 15 patients underwent thoracic endovascular aortic repair, with success rate of 100%, no mortality. The median duration of follow-up was 28 months. There was no aortic related complications nor death. Among the 14 patients treated by medicine 1 patient had formation of dissection and 1 patient with new-onset penetrating ulcer lesion and formation of thoracic aortic aneurysm. These two received thoracic endovascular aortic repair successfully. The proportion of deterioration of intramural hematoma in patients with ulcer-like projection lesions in initial CT imagines was higher than that in patients without ulcer-like projection lesions (7% vs. 33%, P=0.047). The proportion of deterioration of intramural hematoma in patients with intimal defect and intramural blood pool lesions in initial CT imagines was 68% and 69%, respectively.
ConclusionsStrict anti-hypertension medical treatment with timely surgical repair was effective for acute type B intramural hematoma of the aorta. Intramural hematoma with ulcer-like projection lesions are prone to deterioration.
Key words:
Aortic diseases; Tomography, X-ray computed; Follow-up studies
Contributor Information
Weihao Li
Department of Vascular Surgery, Peking University People′s Hospital, Beijing 100044, China
Yang Yang
Tao Zhang
Wei Li
Xuemin Zhang
Qingle Li
Xiaoming Zhang
