Intramural hematoma of the thoracic aorta in octogenarians: is non operation justified?
OBJECTIVE
The prognostic factors and treatment options for thoracic aortic intramural hematoma are controversial. The purpose of this study was to determine the most suitable treatment of this condition in very elderly patients.


METHODS
In a review of the world literature, eight octogenarians with thoracic aortic intramural hematoma were found; to these the three cases reported here must be added. The descending thoracic aorta was involved in eight cases and the ascending/arch in three.


RESULTS
In spite of patients' poor general conditions, the medical treatment group showed survival rates of 85.7% (descending) and 66.6% (ascending/arch), respectively.


CONCLUSIONS
Extensive atherosclerotic changes of the aortic wall in the elderly, combined with control of hypertension, may probably prevent thoracic aortic intramural hematoma from progressing to dissection, with a favourable outcome. An earlier and more accurate preoperative diagnosis by modern diagnostic techniques, including spiral computed tomography (CT), as were performed in our own patients, will allow optimal treatment and increased patient survival.
Porcellini
M
M
Department of Vascular Surgery, Medical School, Federico II, University, Naples, Italy.
Elia
S
S
Camera
L
L
Bracale
G
G
D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D001027:Aortography; D001161:Arteriosclerosis / Q000150:complications; D004359:Drug Therapy, Combination; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D008297:Male; D009543:Nifedipine / Q000627:therapeutic use*; D009599:Nitroprusside / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014665:Vasodilator Agents / Q000627:therapeutic use*
D000700:Analgesics; D014665:Vasodilator Agents; D009599:Nitroprusside; D009543:Nifedipine