Interdisciplinary expert consensus on management of type B intramural haematoma and penetrating aortic ulcer.
An expert panel on the treatment of type B intramural haematoma (IMH) and penetrating atherosclerotic ulcer (PAU) consisting of cardiologists, cardiothoracic surgeons, vascular surgeons and interventional radiologists reviewed the literature to develop treatment algorithms using a consensus method. Data from 46 studies considered relevant were retrieved for a total of 1386 patients consisting of 925 with IMH, and 461 with PAU. The weighted mean 30-day mortality from IMH was 3.9%, 3-year aortic event-related mortality with medical treatment 5.4%, open surgery 23.2% and endovascular therapy 7.1%. In patients with PAU early and 3-year aortic event-mortality rates with open surgery were 15.9 and 25.0%, respectively, and with TEVAR were 7.2 and 10.4%, respectively. According to panel consensus statements, haemodynamic instability, persistent pain, signs of impending rupture and progressive periaortic haemorrhage in two successive imaging studies require immediate surgical or endovascular treatment. In the absence of these complications, medical treatment is warranted, with imaging control at 7 days, 3 and 6 months and annually thereafter. In the chronic phase, aortic diameter >55 mm or a yearly increase ≥ 5 mm should be considered indications for open surgery or thoracic endovascular treatment, with the latter being preferred. In complicated type B aortic PAU and IMH, endovascular repair is the best treatment option in the presence of suitable anatomy.
Department of Cardiology, Hospital Universitario Vall d'Hebrón, Barcelona, Spain aevangel@vhebron.net.
Arturo
A
Evangelista
Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
Martin
M
Czerny
Department of Cardiology, University of Rostock, Rostock, Germany.
Christoph
C
Nienaber
Department of Cardiovascular Surgery, AZ St Jan Hospital, Brugge, Belgium.
Marc
M
Schepens
Department of Radiology, Hôpital CHU Rangueil, Toulouse, France.
Hervé
H
Rousseau
Department of Vascular Surgery, Hospital San Camillo-Forlanini, Rome, Italy.
Piergiorgio
P
Cao
Department of Cardiology, Hospital Universitario Vall d'Hebrón, Barcelona, Spain.
Sergio
S
Moral
Department of Interventional Cardiology, San Salvatore Hospital, Pesaro, Italy.
Rossella
R
Fattori
D000368:Aged; D001018:Aortic Diseases / Q000601:surgery*; D032921:Consensus; D057510:Endovascular Procedures / Q000379:methods*; D006406:Hematoma / Q000601:surgery*; D006801:Humans; D012189:Retrospective Studies; D013903:Thoracic Surgery / Q000379:methods*; D014456:Ulcer / Q000601:surgery*
Intramural haematoma; Penetrating aortic ulcers; Thoracic endovascular therapy