title: Novel insights into the mechanisms and treatment of intramural hematoma affecting the entire thoracic aorta.
abstract: 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.
authors.affiliation: Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria. michael.grimm@meduniwien.ac.at
authors.forename: Michael
authors.initials: M
authors.lastname: Grimm
authors.forename: Christian
authors.initials: C
authors.lastname: Loewe
authors.forename: Roman
authors.initials: R
authors.lastname: Gottardi
authors.forename: Martin
authors.initials: M
authors.lastname: Funovics
authors.forename: Daniel
authors.initials: D
authors.lastname: Zimpfer
authors.forename: Suzanne
authors.initials: S
authors.lastname: Rodler
authors.forename: Marion
authors.initials: M
authors.lastname: Dorfmeister
authors.forename: Maria
authors.initials: M
authors.lastname: Schoder
authors.forename: Johannes
authors.initials: J
authors.lastname: Lammer
authors.forename: Seyedhossein
authors.initials: S
authors.lastname: Aharinejad
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
mesh_terms: 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