Intramural hematoma of the arch and ascending aorta owing to acute aortic syndrome of the descending aorta: to stent or not to stent?
OBJECTIVE
To report thoracic stent-graft repair in patients with acute aortic syndromes, an intramural hematoma (IMH), and intractable pain despite maximum medical therapy.


METHODS
Since January 2002, 4 patients [2 men (40 and 53 years old) and 2 woman (62 and 83 years old)] with type B aortic dissection have presented with an IMH >3 mm in the aortic arch. The patients were treated with a "freeflo" Valiant thoracic stent-graft, which was deployed under "zero aortic pressure" using either adenosine arrest or rapid ventricular pacing. To enhance false lumen thrombosis, a distal extension was inserted when a significant re-entry was observed in the mid third of the descending thoracic. The procedures were successful; over a follow-up ranging to 17 months, the patients have been asymptomatic, with resolution of all the IMHs.


CONCLUSIONS
Thoracic stent-graft treatment of acute aortic syndromes of the descending aorta complicated by arch IMH is feasible. Success of the procedure may rely on optimal stent-graft selection with minimal graft oversizing, deployment under "zero aortic pressure" using rapid ventricular pacing, and more liberal revascularization of the left subclavian artery.
Department of Cardiac Surgery, Laval Hospital, Québec City, Canada. lucie.gosselin.hl@ssss.gouv.qc.ca
François
F
Dagenais
Eric
E
Dumont
Pierre
P
Voisine
D000208:Acute Disease; D000328:Adult; D000369:Aged, 80 and over; D001011:Aorta; D001013:Aorta, Thoracic; D001015:Aortic Arch Syndromes / Q000150:complications* / Q000601:surgery*; D005260:Female; D006406:Hematoma / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents