Endovascular stent-graft management of aortic intramural hematomas.
OBJECTIVE
To report initial experience with endovascular stent-grafting in aortic intramural hematoma (IMH).


METHODS
From 2000 to 2006, 15 patients (mean age, 67 years; range, 54-83 y) underwent endovascular treatment of aortic IMH. Thirteen patients were admitted for acute aortic syndrome and two for traumatic aortic injury. An endovascular procedure was performed as primary treatment for four patients (type A IMH, n = 3; type B IMH, n = 1) and as a second-line therapy in 11 patients because of unfavorable evolution (type A IMH, n = 1; type B IMH, n = 10). All stent-grafts were placed in the descending aorta, even for type A IMH. The mean follow-up was 21 months (range, 6-72 months).


RESULTS
The primary success rate was 93%, with complete exclusion of the lesion (n = 14). Exclusion was partial for one patient with a type I endoleak (7%). The 30-day mortality rate was zero. IMH evolution was favorable in all cases, with decreased aortic wall thickening (n = 8) or complete regression (n = 7). Complications associated with endovascular repair were mainly related to aneurysm formation (20%). The late death rate was 7%.


CONCLUSIONS
Endovascular stent-graft treatment can be performed in the management of complicated IMH, even in some cases of type A IMH, when an intimal lesion is located in the isthmus or descending aorta with contraindications to surgery. This procedure offers low morbidity and mortality rates, representing a feasible therapeutic option especially for elderly patients with comorbidities. Further studies are necessary to confirm these preliminary results.
Monnin-Bares
Valérie
V
Department of Radiology, Centre Hospitalier Universitaire A. Michallon, Grenoble University 1, La Tronche, BP217, Grenoble 38043, France. val_monnin@yahoo.fr
Thony
Frédéric
F
Rodiere
Mathieu
M
Bach
Vincent
V
Hacini
Rachid
R
Blin
Dominique
D
Ferretti
Gilbert
G
D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000175:diagnosis* / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D006406:Hematoma / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome