title: Treatment indications for and outcome of endovascular repair of type B intramural aortic hematoma.
abstract: OBJECTIVE
  The aim of this study was to analyze the outcome of thoracic endovascular aortic repair (TEVAR) and medical therapy in patients with aortic intramural hematoma type B (IMHB).
  
  
  METHODS
  Between January 2004 and January 2014, 41 IMHB patients were treated; 28 underwent TEVAR (16 male; median age, 69 years; group I) plus best medical therapy (BMT), whereas 13 had BMT alone (6 male; median age, 69 years; group II). Study end points were assessment of indications for TEVAR and BMT, clinical outcome, and evaluation of aortic morphology over time. Median follow-up was 32 months for group I and 40 months for group II.
  
  
  RESULTS
  In group I, TEVAR was immediately performed in 7 of 28 cases because of pain and imaging results (penetrating aortic ulcers, n = 4; intramural blood pools, n = 3). In 21 of 28 cases, TEVAR was undertaken because of clinical or radiologic signs of progression at a median of 10 days (range, 2-223 days). The median number of stent grafts implanted was two (range, 1-3). The median length of covered aorta was 15 cm (range, 9.5-33.4 cm). Technical success was achieved in 25 of 28. In-hospital mortality was 1 of 28 in group I and 0 of 13 in group II. Survival in group I was 81.5%, 77.8%, and 67% at 1, 2, and 4 years. There was no death in group II during follow-up. Aortic reinterventions were performed in 6 of 28 group I cases, including 2 open conversions for retrograde type A dissection. Aortic diameter decreased during follow-up in 10% in group I (vs 3% in group II; P = .039). In group I, complete remodeling was seen in 7 of 27, regression in the remaining 20. In group II, complete remodeling was seen in 3 of 12; regression was seen in 9 of 12. No patient in group II required invasive treatment.
  
  
  CONCLUSIONS
  BMT is justified in uncomplicated IMHB. However, IMHB becomes complicated in the majority of patients within 20 days. TEVAR in complicated IMHB is feasible but associated with a substantial aortic reintervention rate, reflecting technical challenges and fragile aortic wall conditions.
authors: Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: moritz.bischoff@med.uni-heidelberg.de.
authors: Moritz S
authors: MS
authors: Bischoff
authors: Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors: Katrin
authors: K
authors: Meisenbacher
authors: Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany.
authors: Michael
authors: M
authors: Wehrmeister
authors: Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors: Dittmar
authors: D
authors: Böckler
authors: Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors: Drosos
authors: D
authors: Kotelis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D005858:Germany; D006406:Hematoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D066253:Vascular Remodeling