title: Aortic branch artery pseudoaneurysms associated with intramural hematoma: when and how to do endovascular embolization.
abstract: OBJECTIVE
  To describe when and how to perform endovascular embolization of aortic branch artery pseudoaneurysms associated with type A and type B intramural hematoma (IMH) involving the descending thoracic and abdominal aorta (DeBakey I and III) that increased significantly in size during follow-up.
  
  
  METHODS
  Sixty-one patients (39 men; mean ± standard deviation age 66.1 ± 11.2 years) with acute IMH undergoing at least two multidetector computed tomographic examinations during follow-up for 12 months or longer were enrolled. Overall, 48 patients (31 men, age 65.9 ± 11.5) had type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III).
  
  
  RESULTS
  Among the 48 patients, 26 (54 %; 17 men, aged 64.3 ± 11.4 years) had 71 aortic branch artery pseudoaneurysms. Overall, during a mean follow-up of 22.1 ± 9.5 months (range 12-42 months), 31 (44 %) pseudoaneurysms disappeared; 22 (31 %) decreased in size; two (3 %) remained stable; and 16 (22 %) increased in size. Among the 16 pseudoaneurysms with increasing size, five of these (three intercostal arteries, one combined intercostobronchial/intercostal arteries, one renal artery), present in five symptomatic patients, had a significant increase in size (thickness >10 mm; width and length >20 mm). These five patients underwent endovascular embolization with coils and/or Amplatzer Vascular Plug. In all patients, complete thrombosis and exclusion of aortic pseudoaneurysm and relief of back pain were achieved.
  
  
  CONCLUSIONS
  Aortic branch artery pseudoaneurysms associated with type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III) may be considered relatively benign lesions. However, a small number may grow in size or extend longitudinally with clinical symptoms during follow-up, and in these cases, endovascular embolization can be an effective and safe procedure.
authors.affiliation: Department of Radiology and Interventional Radiology, IRCCS San Martino University Hospital, IST, National Institute for Cancer Research, Largo Rosanna Benzi 10, 16132, Genova, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Ferro
authors.forename: Umberto G
authors.initials: UG
authors.lastname: Rossi
authors.forename: Sara
authors.initials: S
authors.lastname: Seitun
authors.forename: Flavio
authors.initials: F
authors.lastname: Scarano
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Passerone
authors.forename: David M
authors.initials: DM
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000628:therapy*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D016009:Chi-Square Distribution; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D055989:Septal Occluder Device; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome