Novel insights into the mechanisms and treatment of intramural hematoma affecting the entire thoracic aorta.
BACKGROUND
The purpose of this study was to address a previously not described mechanism underlying intramural hematoma (IMH) of the entire thoracic aorta and to test the hypothesis whether endovascular stent graft placement in this particular mechanism could be beneficial.


METHODS
Within a 5-year period, we treated 8 patients with IMH affecting the entire thoracic aorta. The presumed site of initial plaque rupture was chosen as target for endovascular stent graft placement.


RESULTS
In all patients, a small atherosclerotic plaque at the free lateral wall or at the concavity of the distal aortic arch could be identified as initial site of IMH. Endovascular stent graft placement was performed successfully in all patients. By covering the suspected primary lesion, resorption of IMH especially within the ascending aorta could be achieved. Mean follow-up is 16 months (range, 1 to 25).


CONCLUSIONS
Plaque rupture may be identified as the cause of IMH in a previously unrecognized subgroup of patients. If at the convexity of the distal arch, supra-aortic branches prevent retrograde extension toward the ascending aorta. If at the free lateral wall or at the concavity, IMH may affect the entire thoracic aorta, owing to the lack of the natural barrier of the supra-aortic branches. Endovascular stent graft placement of this plaque-associated IMH may be more effective and less invasive than conventional surgery to treat the entire thoracic aortic disease.
Grimm
Michael
M
Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria. michael.grimm@meduniwien.ac.at
Loewe
Christian
C
Gottardi
Roman
R
Funovics
Martin
M
Zimpfer
Daniel
D
Rodler
Suzanne
S
Dorfmeister
Marion
M
Schoder
Maria
M
Lammer
Johannes
J
Aharinejad
Seyedhossein
S
Czerny
Martin
M
D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed