title: Outcomes of patients with acute type a aortic intramural hematoma.
abstract: BACKGROUND
  The proper treatment option for patients with type A intramural hematoma (IMH), a variant form of classic aortic dissection (AD), remains controversial. We assessed the outcome of our institutional policy of urgent surgery for unstable patients and initial medical treatment for stable patients with surgery in cases with complications.
  
  
  RESULTS
  Among 357 consecutive patients with type A acute aortic syndrome, 101 (28.3%) had IMH and 256 had AD. Urgent operations were performed in 224 patients with AD (87.5%) and 16 with unstable IMH (15.8%; P<0.001). The remaining 85 stable IMH patients received initial medical treatment, and adverse clinical events developed in 31 patients (36.5%) within 6 months, which included development of AD (n=25), delayed surgery (n=25), or death (n=6). Initial aorta diameter and hematoma thickness were independent predictors for development of these events, and the best cutoff values were 55 and 16 mm, respectively. The overall hospital mortality was lower in IMH patients than in AD patients (7.9% [8/101] versus 17.2% [44/256]; P=0.0296) and was comparable to that of surgically treated AD patients (7.9% versus 10.7% [24/224]; P=0.56). The 1-, 2-, and 3-year survival rates of IMH patients were 87.6+/-3.6%, 84.9+/-3.7%, and 83.1+/-4.1%, respectively. There was no statistical difference of overall survival rates between patients with IMH and surgically treated AD patients (P=0.787).
  
  
  CONCLUSIONS
  The clinical outcome of IMH patients receiving treatment by our policy was comparable to that of surgically treated AD patients. However, adverse clinical events were not uncommon with medical treatment alone, and initial aorta diameter and hematoma thickness may identify patients who might benefit from urgent surgery.
authors.affiliation: Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong Songpa-gu, Seoul, 138-736 South Korea. jksong@amc.seoul.kr
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Song
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Yim
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Ahn
authors.forename: Dae-Hee
authors.initials: DH
authors.lastname: Kim
authors.forename: Joon-Won
authors.initials: JW
authors.lastname: Kang
authors.forename: Taek Yeon
authors.initials: TY
authors.lastname: Lee
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Song
authors.forename: Suk Jung
authors.initials: SJ
authors.lastname: Choo
authors.forename: Duk-Hyun
authors.initials: DH
authors.lastname: Kang
authors.forename: Cheol Hyun
authors.initials: CH
authors.lastname: Chung
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Lee
authors.forename: Tae-Hwan
authors.initials: TH
authors.lastname: Lim
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D005260:Female; D006406:Hematoma / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models