Sergio Moral1, Hug Cuéllar2, Gustavo Avegliano3, Esther Ballesteros4, Maria Teresa Salcedo5, Ignacio Ferreira-González6, David García-Dorado1, Arturo Evangelista7. 1. Cardiology Department, Hospital General Universitari Vall d'Hebron, Barcelona, Spain. 2. Radiology Department, Hospital General Universitari Vall d'Hebron, Barcelona, Spain. 3. Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina. 4. Radiology Department, Centre d'Atenció Primaria Pare Claret, Institut Català de la Salut, Barcelona, Spain. 5. Pathology Department, Hospital General Universitari Vall d'Hebron, Barcelona, Spain. 6. Cardiology Department, Hospital General Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. 7. Cardiology Department, Hospital General Universitari Vall d'Hebron, Barcelona, Spain. Electronic address: aevangel@vhebron.net.
Abstract
BACKGROUND: Focal intimal disruption (FID) has been described in >20% of type B intramural hematomas (IMH), with unclear prognosis and management. OBJECTIVES: This study aimed to evaluate the short- and long-term evolution of medically treated patients with type B IMH with and without FID. METHODS: There were 107 consecutive patients with acute type B IMH were included prospectively in a multicenter protocol of clinical and imaging follow-up. FID was defined as an intimal disruption with contrast material-filled outpouching from the aorta lumen with a communicating orifice of >3 mm. RESULTS: There were 43 patients (40%) who developed an FID with larger basal maximum aortic diameter and hematoma thickness. Patients with acute FID had a higher risk of aorta-related events than those without FID (hazard ratio: 24.43; 95% confidence interval: 7.65 to 78.04; p < 0.001). Of the 94 discharged patients, 33 (35%) developed an FID within the first 6 months of follow-up: 19 evolved with mild (<1 mm/year), 8 with moderate (1 to 2 mm/year), and 6 with severe (>2 mm/year) aortic enlargement. Chronic FID was not associated with aorta-related events (hazard ratio: 0.98; 95% confidence interval: 0.22 to 4.34; p = 0.987). CONCLUSIONS: The development of FID in the acute phase of type B IMH has a poor prognosis owing to the high risk of aortic rupture. In the chronic phase, most FIDs evolve with slow aortic dilation and without complications. Although acute FIDs should be treated early and invasively, lesions developing in the subacute-chronic phase can be managed with medical treatment and close imaging surveillance.
BACKGROUND: Focal intimal disruption (FID) has been described in >20% of type B intramural hematomas (IMH), with unclear prognosis and management. OBJECTIVES: This study aimed to evaluate the short- and long-term evolution of medically treated patients with type B IMH with and without FID. METHODS: There were 107 consecutive patients with acute type B IMH were included prospectively in a multicenter protocol of clinical and imaging follow-up. FID was defined as an intimal disruption with contrast material-filled outpouching from the aorta lumen with a communicating orifice of >3 mm. RESULTS: There were 43 patients (40%) who developed an FID with larger basal maximum aortic diameter and hematoma thickness. Patients with acute FID had a higher risk of aorta-related events than those without FID (hazard ratio: 24.43; 95% confidence interval: 7.65 to 78.04; p < 0.001). Of the 94 discharged patients, 33 (35%) developed an FID within the first 6 months of follow-up: 19 evolved with mild (<1 mm/year), 8 with moderate (1 to 2 mm/year), and 6 with severe (>2 mm/year) aortic enlargement. Chronic FID was not associated with aorta-related events (hazard ratio: 0.98; 95% confidence interval: 0.22 to 4.34; p = 0.987). CONCLUSIONS: The development of FID in the acute phase of type B IMH has a poor prognosis owing to the high risk of aortic rupture. In the chronic phase, most FIDs evolve with slow aortic dilation and without complications. Although acute FIDs should be treated early and invasively, lesions developing in the subacute-chronic phase can be managed with medical treatment and close imaging surveillance.
Authors: Carlos Ferrera; Isidre Vilacosta; Beatriz Cabeza; Javier Cobiella; Isaac Martínez; Melchor Saiz-Pardo Sanz; Ana Bustos; Francisco Javier Serrano; Luis Maroto Journal: Vasc Health Risk Manag Date: 2020-06-08