title: Initial medical treatment for acute type a intramural hematoma and aortic dissection.
abstract: BACKGROUND
  There are contradictory reports on outcomes of patients treated for Stanford type A acute intramural hematoma (IMH) and acute aortic dissections (AAD) with thrombosed false lumens. We evaluated short-term clinical outcomes and predictors of adverse outcomes.
  
  
  METHODS
  We retrospectively analyzed 59 symptomatic patients with type A acute IMH and AAD with thrombosed thoracic false lumens who initially received treatment. Survival, aortic death (death from aortic events and sudden deaths), and aortic event-free survival rates were investigated. False lumen thickness ratios (FTR [false lumen thickness/aortic diameter]) were measured by computed tomography scan and the relationship with aortic events was evaluated.
  
  
  RESULTS
  Survival, aortic death-free survival, and aortic event-free survival rates at 2 years were 90.0%, 96.6%, and 55.8%, respectively. Ascending aortic diameters, false lumen thickness of the ascending aortas, and rate of penetrating aortic ulcers in the ascending aortas were higher among patients with aortic events. The FTR of the ascending aorta (FTRA)/FTR of the descending aorta (FTRD) was also higher in these patients (1.3 ± 0.9 versus 0.8 ± 0.5, p = 0.0021). Multivariate analysis revealed FTRA/FTRD greater than 0.98 (odds ratio 5.35; 95% confidence interval: 0.05 to 1.72; p = 0.0431) as an independent predictor of aortic events. An FTRA/FTRD greater than 0.98 predicted aortic events with 87.1% sensitivity and 58.4% specificity.
  
  
  CONCLUSIONS
  High aortic event rates were seen after treatment for type A acute IMH and AAD with thrombosed thoracic false lumens. Nevertheless, short-term survival rates were favorable. An FTRA/FTRD greater than 0.98 may be a highly sensitive predictor for aortic events.
authors.affiliation: Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kokura Northern Ward, Kitakyushu, Fukuoka, Japan. Electronic address: shunchan828@me.com.
authors.forename: Shun
authors.initials: S
authors.lastname: Watanabe
authors.forename: Michiya
authors.initials: M
authors.lastname: Hanyu
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Arai
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nagasawa
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001013:Aorta, Thoracic; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016001:Confidence Intervals; D018572:Disease-Free Survival; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed
chemical_list: D000959:Antihypertensive Agents
keywords: 26; AAD; CT; FT; FTR; FTRA; FTRD; IMH; PAU; acute aortic dissection; computed tomography; false lumen thickness; false lumen thickness ratio; false lumen thickness ratio of the ascending aorta; false lumen thickness ratio of the descending aorta; intramural hematoma; penetrating aortic ulcer