A single-center experience of type B aortic intramural hematoma

Objective The outcomes of the best medical treatment (BMT) and intervention treatment (INT) in a single-center experience were reported in type B intramural hematoma. Methods From February 2015 to February 2021, a total of 195 consecutive patients with type B intramural hematoma were enrolled in the study. The primary endpoint was mortality, while the secondary endpoints included clinical and imaging outcomes. The clinical outcomes were aortic-related death, retrograde type A aortic dissection, stent graft-induced new entry tear (SINE), endoleak, and re-intervention. The imaging outcome was evaluated through the latest follow-up computed tomography angiography (CTA), which included aortic rupture, aortic dissection, aortic aneurysm, rapid growth of aortic diameter, newly developed or enlarged penetrating aortic ulcer (PAU) or ulcer-like projection (ULP) and increased aortic wall thickness. Kaplan-Meier curves were used to assess the association between different treatments. Results Among the enrolled patients, 115 received BMT, while 80 received INT. There was no significant difference in early (1.7% vs. 2.5%; p=1.00) and mid-term all-cause death (8.3% vs. 5.2%; p=0.42) between the BMT and INT group. However, patients underwent INT were at risk of procedure-related complications such as SINE and endoleaks. INT group was associated with a profound decrease in the risk of ULP, including newly developed ULP (4.3% vs. 26.9%; p<.05), ULP enlargement (6.4% vs. 31.3%; p<.05), and a lower proportion of high-risk ULP (10.9% vs. 45.6%; p<.05). Although there was no significant difference in the incidence of intramural hematoma regression between the two groups, the maximum diameter of the descending aorta in patients receiving INT was larger compared to those treated with BMT. Conclusions Based on our limited experience, type B IMH patients treated with BMT or INT shared similar mid-term clinical outcome. Patients underwent INT may have a decreased risk of ULPs but higher risk of procedure-related events and BMT patients should be closely monitored for ULPs progression.