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.
Dagenais
François
F
Department of Cardiac Surgery, Laval Hospital, Québec City, Canada. lucie.gosselin.hl@ssss.gouv.qc.ca
Dumont
Eric
E
Voisine
Pierre
P
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