title: Long-term follow-up of aortic intramural hematoma: predictors of outcome.
abstract: BACKGROUND
  Aortic intramural hematoma (IMH) evolves very dynamically in the short-term to regression, dissection, or aortic rupture. The aim of the present study was to assess the long-term clinical and morphological evolution of medically treated IMH.
  
  
  RESULTS
  Fifty of 68 consecutive patients with aortic IMH monitored clinically and by imaging techniques at 3, 6, and 12 months and annually thereafter were prospectively studied. Mean follow-up was 45+/-31 months. In the first 6 months, total IMH regression was observed in 14 and progression to aortic dissection in 18 patients; in 14 of these, the dissection was localized, and 12 later developed pseudoaneurysm. At the end of follow-up, the IMH had regressed completely without dilatation in 17 patients (34%), progressed to classical dissection in 6 (12%), evolved to fusiform aneurysm in 11 (22%), evolved to saccular aneurysm in 4 (8%), and evolved to pseudoaneurysm in 12 (24%). Evolution to dissection was related to echolucency (P<0.02) and to longitudinal extension of IMH (P<0.01). Multivariate analysis showed an independent association between regression and smaller maximum aortic diameter and between aneurysm formation and atherosclerotic ulcerated plaque and absence of echolucent areas in IMH.
  
  
  CONCLUSIONS
  The most frequent long-term evolution of IMH is to aortic aneurysm or pseudoaneurysm. Complete regression without changes in aorta size is observed in one third of cases, and progression to classical dissection is less common. A normal aortic diameter in the acute phase is the best predictor of IMH regression without complications, and absence of echolucent areas and atherosclerotic ulcerated plaque are associated with evolution to aortic aneurysm.
authors.affiliation: Servei de Cardiología, Hospital General Universitari Vall d'Hebron, Barcelona, Spain. evangel@hg.vhebron.es
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.forename: Rosa
authors.initials: R
authors.lastname: Dominguez
authors.forename: Carmen
authors.initials: C
authors.lastname: Sebastia
authors.forename: Armando
authors.initials: A
authors.lastname: Salas
authors.forename: Gaieta
authors.initials: G
authors.lastname: Permanyer-Miralda
authors.forename: Gustavo
authors.initials: G
authors.lastname: Avegliano
authors.forename: Cristina
authors.initials: C
authors.lastname: Elorz
authors.forename: Teresa
authors.initials: T
authors.lastname: Gonzalez-Alujas
authors.forename: Herminio
authors.initials: H
authors.lastname: Garcia Del Castillo
authors.forename: Jordi
authors.initials: J
authors.lastname: Soler-Soler
mesh_terms: D000784:Aortic Dissection / Q000209:etiology; D017541:Aneurysm, False / Q000209:etiology; D001014:Aortic Aneurysm / Q000145:classification / Q000209:etiology; D001018:Aortic Diseases / Q000150:complications / Q000175:diagnosis*; D018450:Disease Progression; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012075:Remission, Spontaneous; D013995:Time; D014057:Tomography, X-Ray Computed; D014654:Vascular Patency