Our experience in treatment of thoracic aortic intramural hematoma

Abstract

Aim: The purpose of this study was to explain our strategy in treatment patients with intramural hematoma (IMH) and to establish the optimal mode of management patients with type A IMH. Methods: This study retrograde analyzes the treatment strategies for acute IMH managed by our program. We have evaluated 32 patients with IMH, who were admitted at hospital from January 2001to December 2010. On arrival urgent operation was performed for the patients of IMH with cardiac tamponade and persistent pain. Uncomplicated patients with IMH were treated medically. During the early and late follow-up medically treated patients, IMH showed signs of progression to type A dissection, ruptured aneurysm or aneurismal enlargement (>55 mm). Long term survival was evaluated statistically. Results: Three urgent operations were performed with patients type A IMH, succssefully. The rest 29 patients were treated medically (11 type A and 18 type B IMH). Among them, 6 patients with type A and 1 type B were converted to early surgical intevtevtion (one patient died). During a late follow-up 2 patients type A were converted to late surgical intervention (none of them died). During that period 5 of medically treated patients died (1 type A and 4 type B). The 10-years survival rate was 81% for patients with IMH. Conclusion: According to results of our study, we still prefer medical treatment for type B IMH patients. But, we believe that early surgical treatment of acute type A IMH have a better results than medical treatment.