Clinical characteristics and outcomes of Stanford type B aortic intramural hematoma: A single centre experience
ObjectiveTo compare the clinical characteristics of Stanford type B aortic intramural hematoma (IMH) and Stanford type B aortic dissection (AD), and to identify the differences between thoracic endovascular aortic repair (TEVAR) and medical management (MM) in the Stanford type B IMH patients.Methods...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-01-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2022.1071600/full |
| _version_ | 1828071133247700992 |
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| author | Zhigong Zhang Feng Lin Feng Lin Zhipeng He Haoran Wang Xingyang Zhu Xingyang Zhu Tingting Cheng |
| author_facet | Zhigong Zhang Feng Lin Feng Lin Zhipeng He Haoran Wang Xingyang Zhu Xingyang Zhu Tingting Cheng |
| author_sort | Zhigong Zhang |
| collection | DOAJ |
| description | ObjectiveTo compare the clinical characteristics of Stanford type B aortic intramural hematoma (IMH) and Stanford type B aortic dissection (AD), and to identify the differences between thoracic endovascular aortic repair (TEVAR) and medical management (MM) in the Stanford type B IMH patients.MethodsA retrospective observational study was conducted in patients treated between January 2015 and December 2016. The clinical characteristics and CT images of patients with type B IMH and type B AD were compared, and the clinical characteristics and CT images of patients in the type B IMH group who were treated with TEVAR and MM were compared.ResultsA total of 176 patients were included in this study, including 62 patients of type B IMH and 114 patients of type B AD. Five patients died in the IMH group and three in the AD group. The proximal hematoma or entry tear in both groups was mainly located in the descending aorta, and the proportion of the iliac artery involved in the AD group was significantly higher than that in the IMH group (31.6% vs. 8.1% P < 0.05). There were 50 MM patients and 12 TEVAR patients in the IMH group. No death occurred in the TEVAR group, while five patients in the MM group died. Seven patients in the MM group had disease progression vs. 12 in the TEVAR group (P < 0.05). The patients in the TEVAR group had more intima lesions than those in the MM group (83.3% vs. 30.0%, P < 0.05). TEVAR group involved more iliac artery hematoma than MM group (33.3% vs. 2.0%, P < 0.05). The maximum thickness of hematoma in TEVAR group was 14.9 ± 3.4 mm, which was significantly larger than that of MM group (10.2 ± 2.8 mm) (P < 0.05).ConclusionIn the diagnosis of IMH, patients' symptoms and high-risk signs of CTA should be paid attention to. TEVAR therapy should be actively considered on the basis of effective medical management when there are intima lesions (ULP/PAU), increased aortic diameter and hematoma thickness, extensive hematoma involvement, and pleural effusion. |
| first_indexed | 2024-04-11T00:48:47Z |
| format | Article |
| id | doaj.art-310fbc7530bf47dfbaa7855b6923790a |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-11T00:48:47Z |
| publishDate | 2023-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-310fbc7530bf47dfbaa7855b6923790a2023-01-05T10:44:31ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2023-01-01910.3389/fsurg.2022.10716001071600Clinical characteristics and outcomes of Stanford type B aortic intramural hematoma: A single centre experienceZhigong Zhang0Feng Lin1Feng Lin2Zhipeng He3Haoran Wang4Xingyang Zhu5Xingyang Zhu6Tingting Cheng7Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, ChinaDepartment of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, ChinaAnhui Public Health Clinical Center, Hefei, ChinaDepartment of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, ChinaDepartment of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, ChinaDepartment of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, ChinaAnhui Public Health Clinical Center, Hefei, ChinaDepartment of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, ChinaObjectiveTo compare the clinical characteristics of Stanford type B aortic intramural hematoma (IMH) and Stanford type B aortic dissection (AD), and to identify the differences between thoracic endovascular aortic repair (TEVAR) and medical management (MM) in the Stanford type B IMH patients.MethodsA retrospective observational study was conducted in patients treated between January 2015 and December 2016. The clinical characteristics and CT images of patients with type B IMH and type B AD were compared, and the clinical characteristics and CT images of patients in the type B IMH group who were treated with TEVAR and MM were compared.ResultsA total of 176 patients were included in this study, including 62 patients of type B IMH and 114 patients of type B AD. Five patients died in the IMH group and three in the AD group. The proximal hematoma or entry tear in both groups was mainly located in the descending aorta, and the proportion of the iliac artery involved in the AD group was significantly higher than that in the IMH group (31.6% vs. 8.1% P < 0.05). There were 50 MM patients and 12 TEVAR patients in the IMH group. No death occurred in the TEVAR group, while five patients in the MM group died. Seven patients in the MM group had disease progression vs. 12 in the TEVAR group (P < 0.05). The patients in the TEVAR group had more intima lesions than those in the MM group (83.3% vs. 30.0%, P < 0.05). TEVAR group involved more iliac artery hematoma than MM group (33.3% vs. 2.0%, P < 0.05). The maximum thickness of hematoma in TEVAR group was 14.9 ± 3.4 mm, which was significantly larger than that of MM group (10.2 ± 2.8 mm) (P < 0.05).ConclusionIn the diagnosis of IMH, patients' symptoms and high-risk signs of CTA should be paid attention to. TEVAR therapy should be actively considered on the basis of effective medical management when there are intima lesions (ULP/PAU), increased aortic diameter and hematoma thickness, extensive hematoma involvement, and pleural effusion.https://www.frontiersin.org/articles/10.3389/fsurg.2022.1071600/fullintramural hematomaTEVARmedical managementaortic dissectionmaximum aortic diameter |
| spellingShingle | Zhigong Zhang Feng Lin Feng Lin Zhipeng He Haoran Wang Xingyang Zhu Xingyang Zhu Tingting Cheng Clinical characteristics and outcomes of Stanford type B aortic intramural hematoma: A single centre experience Frontiers in Surgery intramural hematoma TEVAR medical management aortic dissection maximum aortic diameter |
| title | Clinical characteristics and outcomes of Stanford type B aortic intramural hematoma: A single centre experience |
| title_full | Clinical characteristics and outcomes of Stanford type B aortic intramural hematoma: A single centre experience |
| title_fullStr | Clinical characteristics and outcomes of Stanford type B aortic intramural hematoma: A single centre experience |
| title_full_unstemmed | Clinical characteristics and outcomes of Stanford type B aortic intramural hematoma: A single centre experience |
| title_short | Clinical characteristics and outcomes of Stanford type B aortic intramural hematoma: A single centre experience |
| title_sort | clinical characteristics and outcomes of stanford type b aortic intramural hematoma a single centre experience |
| topic | intramural hematoma TEVAR medical management aortic dissection maximum aortic diameter |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2022.1071600/full |
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