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Management strategies in acute type B aortic intramural hematoma

Tanaka, Akiko; Leake, Samuel; Estrera, Anthony L.

doi: 10.1097/HCO.0000000000000453
DISEASES OF THE AORTA, PERIPHERAL AND PULMONARY DISEASES: Edited by Alan C. Braverman
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Purpose of review Intramural hematoma (IMH) is one of the acute aortic syndromes. IMH was originally noted as an ‘aortic dissection without intimal tear.’ It had been speculated that IMHs were caused by ruptured vasa vasorum in the aortic media and distinguished from classical aortic dissections. However, the majority of IMHs are now detected with an intimal defect using high-resolution computed tomography, which implies that IMHs may be a subset of aortic dissections with very limited flow in the false lumen. Management of IMHs had been controversial, but guidelines published in the early 2010 s recommend treating IMHs as classical aortic dissections: surgical repairs were indicated for type A IMHs; complicated acute type B IMHs were treated with endovascular or open repairs and uncomplicated type B IMHs were to be managed with antiimpulse therapy and close surveillance. To date, based on the favorable long-term outcomes of preemptive thoracic endovascular aortic repair (TEVAR) for uncomplicated type B aortic dissections, early TEVAR for uncomplicated type B IMHs has been attempted. In this review, we describe the pathophysiology and management strategies for acute IMHs.

Recent findings IMHs have intimal tears or disruptions in 70–80%.

Summary Type B IMH should be managed with antiimpulse therapy, unless the patient has persistent pain or large ulcer-like projection.

Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth) and Memorial Hermann Hospital, Houston, Texas, USA

Correspondence to Anthony L. Estrera, MD, FACS, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), 6400 Fannin St., Ste 2850, Houston, TX 77030, USA. Tel: +1 713 486 5129; fax: +1 713 512 7200; e-mail: Anthony.L.Estrera@uth.tmc.edu

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