Aortic intramural hematoma treatment Patients who had identifiable intimal flap, tear, or penetrating aortic ulcer were excluded from the study. This study compared the pathologic characteristics of intramural hematoma with those of Treatment of Aortic Intramural Hematoma. Acute aortic syndrome is an acute, potentially fatal pathology within the wall of the aorta, including aortic dissection, intramural hematoma (IMH), and penetrating atherosclerotic ulcer. Google Scholar. Usefulness of the initial noninvasive imaging study to predict the adverse outcomes in the medical treatment of acute type A aortic intramural hematoma. The vast majority Intramural hematoma (IMH) of the aorta is a well-known variant of aortic dissection; however, the optimal initial treatment strategy for type A IMH remains controversial. The term denoted a collection of painful and life-threatening aortic conditions, including acute aortic dissection (AAD), intramural hematoma Aortic intramural hematoma (IMH) is related to but is pathologically distinct from aortic dissection. Methods: Between January 2001 and December 2009, 56 consecutive patients were enrolled in a prospective study to evaluate stent-graft repair versus medical therapy for acute type B IMH Acute aortic intramural hematoma is a subtype of an acute aortic syndrome in which blood is present within the aortic wall without evidence of intimal injury. Treatment usually involves surgery or medication. Aortic intramural hematoma (IMH) is an important acute aortic syndrome that presents symptoms similar to those of classic aortic dissection. Surgical treatment of an aortic IMH involving the ascending aorta with open replacement of ascending aorta results in lower mortality and longer survival compared to Intramural hematoma (IMH) is on the spectrum of acute aortic syndrome, but optimal management is poorly understood. 1, 2 The evolution from IMH to overt dissection or even rupture may occur suddenly or is heralded by ongoing acute aortic (pain) syndrome. Patients may also have to take Purpose: To report a prospective study that explored the therapeutic strategies in the treatment of type B aortic intramural hematoma (IMH) and evaluated the role of endovascular repair. If the hematoma develops in the area of the aorta that descends into the abdomen, medication alone may be used to treat it. The purpose of this study was to compare the outcomes following emergency surgery or conservative treatment Because it is a life-threatening condition, an aortic IMH should be treated immediately. This study aims to summarize the short-term results of endovascular repair in the Aortic intramural hematoma (IMH) is an acute, potentially lethal disorder that is similar to but pathologically distinct from acute aortic dissection. 2, 3 IMH is a contained aortic wall hematoma The term "acute aortic syndrome" (AAS) was first used in 1998 by Vilacosta et al. Although most resolve spontaneously or with conservative therapy, several cases of AIH may complicate into classic aortic dissection with subsequent risk of aortic rupture and visceral malperfusion, thus needing urgent or preemptive thoracic Keywords: Aortic intramural hematoma; Acute aortic sydromes; Aortic dissection; Thoracal endovascular aortic replacement Introduction Acute aortic Syndromes (AAS), İncluding İntramural Hematoma (IMH), pose serious threats within the aortic Wall [1]. Aggressive control of blood pressure with intensive care unit monitoring has been our initial management. The mainstay of treatment for uncomplicated TBAD is medical management in the form of blood pressure and Aortic intramural hematoma (IMH) is a rare disease. The natural history of acute aortic IMH is highly variable, including hematoma resolution, progression to aortic dissection, Acute aortic syndromes include a variety of overlapping clinical and anatomic diseases. AAS includes a heterogeneous group of patients; however, the underlying pathology uni- pertensive treatment, maximum aortic diameter > 55 mm, PAU base > 20 mm or depth > 15 mm, IMH with signifi-cant periaortic hemorrhage, or persistent or Acute aortic syndrome can be life-threatening and emergency surgery is often needed. Beta-blockers consist the mainstay of treatment in the medical management of type B IMH as it Aortic intramural hematoma (AIH) is an entity within the acute aortic syndrome. Methods and Results— Between October 1999 and May 2008, 251 patients with acute type A aortic An aortic intramural hematoma (IMH) is defined as the presence of blood within the aortic wall without intimal disruption or an identifiable entry point on imaging. 168 patients with aortic Purpose: Aortic intramural hematoma has been considered a precursor of aortic dissection, and the same treatment strategy, usually involving surgery, has been applied to both conditions. Usefulness of the initial noninvasive imaging study to predict the adverse outcomes in the medical treatment Objectives: The proper therapeutic management for acute type A aortic intramural hematoma (IMH) is still controversial. IMH treatment and prognosis. requiring treatment of the distal aortic arch or descending thoracic aorta. The primary end point was mortality, and the secondary end points included Background: Initial optimal management of acute type A aortic dissection (ATAAD) with intramural hematoma (ATAIMH) remains controversial, especially between centers in the Eastern vs. Aortic Intramural hematoma (IMH) is a life-threatening aortic disease included within acute aortic syndrome, together with aortic dissection and penetrating aortic ulcer (PAU). The aim of this study was to evaluate outcomes of patients with type B IMH (TBIMH) after best Intramural hematoma (IMH) is a life-threatening aortic disease included within acute aortic syndrome, together with aortic dissection and penetrating aortic ulcer (PAU). Aortic intramural hematoma has been considered a precursor of overt aortic dissection1,2; however, the pathophysiologic mechanism, evolution, and prognosis are rather different from those of Intramural Hematoma of the Descending Aorta—Natural History and Treatment, Controversies in Aortic Dissection Meta-analysis of 143 reported cases of aortic intramural hematoma, The An aortic intramural hematoma (IMH) is defined as the presence of blood within the aortic wall without intimal disruption or an identifiable entry point on imaging. 2003; 108 (Suppl 1):II324–II328 Aortic intramural hematoma (IMH) is an acute aortic disease, defined by the presence of hemorrhage within the aortic wall, and no evidence of intimal tear. While patient risk Type A Aortic Intramural Hematoma Dimitrios Vlastos, MD, Francisco Fernandes, MD, Ishaansinh Chauhan, MD, Saeed Mirsadraee, MD, George Asimakopoulos, MD Conservative Treatment of Type A Aortic IMH JULY 2020:1143– 7 1144. Conversion to typical dissection remains a concern. . Acute aortic syndrome is an entity comprised of multiple different aortic pathologies that may require urgent medical treatment and are associated with significant morbidity and mortality. Because it is a life-threatening condition, an aortic IMH should be treated immediately. Methods: This was a retrospective study of all patients who had intramural hematoma at our institution from 1989 to 1994. aneurysm formation, and ulceration. Their incidence is significantly lower compared to aortic dissection. Further expanding on this notion, we present a case Aortic intramural hematoma (IMH) has been recognized as a variant of aortic dissection (AD) and is detected with the use of noninvasive imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and transesophageal echocardiography (TEE). Under the assumption that major adverse aortic events (MAAEs) would be related to the location of primary intimal tear, we reviewed preoperative computed tomography scan findings. The predictors of progression of IMH to dissection and rupture are still unknown, and strategies for management are not established. Methods In this single-center cohort study, we retrospectively analyzed 73 patients with Type A IMH treated at our center from August 1, Within the spectrum of acute aortic syndromes, intramural hematoma (IMH) is a distinct lesion that is characterized by crescentic or circumferential thickening of the aortic wall in the absence of A review of literature on diagnosis and treatment of PAU and IMH was conducted. Aortic intramural hematoma (IMH) is an entity included in the acute aortic syndrome (AAS) together with aortic dissection and penetrating aortic ulcer3. The search was limited to articles on humans only with an abstract available in English. After 15 days of admission to Abstract Acute aortic syndromes include a variety of overlapping clinical and anatomic diseases. IMH, defined as the presence of blood within the medial layer of the Introduction. 1996 Dec;24(6):1022-9. Thus far, only limited data is available and the indications for conservative and endovascular treatment are not well defined. The prognosis after surgical treatment in patients with intramural aortic hematoma is good and is Aortic intramural hematoma Aortic intramural haematoma (IMH) is an atypical form of aortic dissection due to a contained haemorrhage into the aortic wall usually from the vasa vasorum without an intimal tear. This study aimed to analyze the results of the management of patients with acute IMH involving the ascending aorta and The evaluation focused on parameters that were classified as high-risk factors, such as PAU depth >10 mm, PAU diameter >20 mm, the presence of intramural hematoma (IMH), symptoms despite medical treatment or rupture, and haemorrhagic pleural effusion and also an initial aortic diameter at the site of PAU >40 mm, which is also recognized as high-risk factor in Acute aortic syndromes include a variety of overlapping clinical and anatomic diseases. In the European Society of Cardiology (ESC) guidelines the definition of type A IMH is a circular or crescent shaped thickening of > 5 mm of the aortic wall with the absence of a dissecting membrane, Purpose: This report reviews our recent experience with nine patients who had intramural hematoma of the thoracic aorta. Treatment and prognosis. While, in classical aortic dissection, flow communication occurs though a pri-mary intimal tear and blood propagation creates a false lumen, in intramural Intramural hematoma appears to be a distinct entity, although overlap with aortic dissection or penetrating aortic ulcer exists. It is a life-threatening aortic disease that warrants prompt diagnosis and management. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the Aortic intramural hematoma (IMH), characterized by hemorrhage within the media of the aortic wall, may occur with or without intimal disruption. Alth. Between June 2019 and June 2021, 21 patients (16 males and 5 females) with a retrograde Background— The proper treatment option for patients with type A intramural hematoma (IMH), a variant form of classic aortic dissection (AD), remains controversial. Intramural haematoma (IMH) of the ascending aorta (type A) is an occasional variant of the acute aortic syndrome, which is life threatening when left untreated. Surgical treatment of an aortic IMH involving the ascending aorta with open replacement of ascending aorta results in lower mortality and Rupture of the vasa vasorum into the media of the aortic wall results in an aortic intramural hematoma. Rarely, patients with an aortic IMH may have an aberrant subclavian artery. Song JK, et al. Acute aortic intramural hematoma (IMH) is an entity within the spectrum of acute aortic syndrome (AAS), in which a hematoma develops in the media of the aortic wall in the absence of a false lumen and intimal tear []. Patients with asymptomatic PAUs, if associated with high-risk features such as PAU Aortic intramural hematoma (IMH) together with aortic dissection are entities included in AAS . Read the article below to know more. Surgical treatment of an aortic IMH involving the ascending aorta with open replacement of ascending aorta results in lower mortality and The treatment policy for acute intramural hematoma involving the ascending aorta remains controversial. Overview of acute aortic dissection and other acute aortic syndromes Aortic intramural hematoma (IMH) accounts for approximately 10%–25% of acute aortic syndromes (AAS), and multi-slice computed tomography and magnetic resonance imaging are the leading techniques for diagnosis and classification. S324-S328. 1–9 Isolated IMH is characterized by aortic wall hematoma without demonstrable First-in-man ZIPPER™ endograft system for the treatment of symptomatic aortic arch intramural haematoma Eur Heart J Case Rep . We analyzed our experience managing acute type A IMH. Among patients who present with acute IMH affecting the ascending aorta (Type A), Because aortic IMH is a life-threatening condition, treatment is usually needed immediately. Combination of a priori probability, clinical history, laboratory blood test and imaging techniques are the basis for diagnosis of AIH. Penetrating aortic ulcer (PAU), intramural hematoma (IMH) and aortic dissection can occur as isolated processes or can be found in association. The purpose of this study was to compare the outcomes following emergency surgery or conservative treatment for patients with this disease. 1 Unlike aortic dissection, in which an intimal tear and true and false lumens can be identified, IMH is defined as a crescentic collection of blood in the aortic wall without the presence of an intimal tear and is thought to be related to Aortic intramural hematoma (IMH) is related to but is pathologically distinct from aortic dissection. Aortic intramural hematoma (AIH) is an entity within the acute aortic syndrome (AAS). The survival rate is higher for intramural hematoma and penetrating atherosclerotic ulcer than for people with acute aortic dissection. Aortic intramural hematoma (IMH) is described as a hemorrhage within the medial layer of the aortic wall with no detectable blood flow or initial flap in the vessel wall . 1 Introduction. doi: 10. Intramural hematoma (IMH) of the aorta and penetrating aortic ulcer (PAU) are important variant forms of classic double-barrel aortic dissection in patients presenting with acute aortic syndrome. The purpose of this review is to summarize current management strategies for acute aortic syndromes. While, in classical aortic dissection, flow communication occurs though a pri-mary intimal tear and blood propagation creates a false lumen, in intramural Objective: Increasing use of modern high-resolution imaging techniques yields to describe very early stages of aortic pathology which, if left untreated, may lead to overt aortic dissection. Aortic dissection is a well-studied disorder, but the other most prominent disorders within the scope of acute aortic syndrome, penetrating aortic ulcer and intramural hematoma, are more nebulous in terms of their pathophysiology and treatment strategies. pathologies, including dissection, intramural hematoma (IMH), and penetrating aortic ulcer (PAU). The sooner you receive treatment, the better your chances of a favorable outcome. In this potentially lethal entity, there is hemorrhage into the aortic media in the absence of an intimal tear. Most procedures for IMH involve treatment of the aortic arch, which necessitates unilateral cerebral perfusion during certain parts of the operation. Intramural hematoma (IMH) is defined by the presence of hemorrhage within the aortic wall without intimal disruption or an identifiable entry point on imaging. Preliminary treatment is usually performed in an intensive care unit, as these The proper therapeutic management for acute type A aortic intramural hematoma (IMH) is still controversial. Recent studies support surgical treatment (ie, aortic root replacement) for IMH involving the ascending aorta, although some subsets of this population may be at lower risk and may Conclusions Intramural aortic hematoma is a form of AAS with independent pathogenesis but similar progression, complications, and treatment as aortic dissection and thus demands efficient Intramural haematoma (IMH) of the aorta is attracting growing interest as a variant of aortic dissection and is more frequently diagnosed by modern tomographic imaging modalities in the evaluation of acute aortic syndromes. However, the outcomes of patients with aortic intramural hematoma who are treated medically, including the remodeling process that occurs after an acute event, are not known. Circulation. 1 Aortic dissection, intramural hematoma (IMH), and penetrating aortic ulcer (PAU) comprise the majority of cases of acute aortic syndrome. Aortic dissection is a life-threatening medical condition, and immediate diagnosis and treatment are crucial. Objective This study aimed to compare hospital and long-term clinical outcomes associated with various treatment methods for Stanford A type aortic intramural hematoma (IMH) to provide a reference for clinical decision-making. All these entities are potentially life threatening, so prompt diagnosis and treatment is of para-mount Endovascular treatment, if anatomically suitable, should be considered as first line treatment for symptomatic PAUs. In this review, we discuss the pathophysiology, epidemiology, clinical presentation, diagnostic imaging, surgery and clinical outcomes associated with IMH. 2,3 Although clinical features Purpose of Review Acute aortic syndromes, including aortic dissection, intramural hematoma, and penetrating aortic ulcer, are a group of highly morbid, related pathologies that are defined by compromised aortic wall integrity. d 78F with penetrating aortic ulcer of the abdominal aorta adjacent to the celiac axis. If the condition occurs in the area of the Treatment of Intramural Hematoma Treatment options include pharmacologic measures (beta blockers), endovascular exclusion and surgical evacuation. Under this denomination, we consider several pathologies with a common clinical presentation: classic aortic dissection, intramural hematoma, penetrating aortic ulcer, and incomplete dissection. While in classical aortic dissection flow communication occurs through a primary intimal tear and blood propagation creates a false lumen, in IMH, hemorrhage occurs within the aortic wall in the absence of primary intimal disruption ( 5 ). Penetrating aortic ulcer (PAU), intramural hematoma (IMH) and aortic dissection can occur as isolated The current treatment for retrograde ascending aortic intramural hematoma (RAIMH) remains challenging. First diagnosed as a unique condition in 1986 by Stanson et al, an isolated PAU is characterized by disruption of the arterial intima and elastic lamina that extends into the media within the atherosclerotic Medical, open surgical, and endovascular treatment is tailored depending on clinical presentation, timing, and location within the aorta. Background— Management of acute type A intramural hematoma (IMH) remains controversial, varying from immediate surgery to medical management only. have been found to reliably predict adverse outcomes in the context of conservative treatment (2–4,6), Background—Acute aortic intramural hematoma (IMH) is an important subgroup of aortic dissection, and controversy surrounds appropriate management. Characteristic findings of an aortic intramural hematoma include a crescentic hyperattenuating fluid collection at unenhanced computed tomography (CT) and a smooth, nonenhancing, thickened aortic wall at contrast material–enhanced CT. Most surgeries for acute type A intramural hematoma are performed on the proximal aorta alone regardless of the intimal tear site. b 42 M with hypertensive crisis and TBAD. Results: Among these nine Aortic intramural hematoma (IMH) is an important acute aortic syndrome that presents symptoms similar to those of classic aortic dissection. 1,2 The underlying pathophysiological mechanism is different in each of Aortic intramural hematoma (IMH) is an entity included in the acute aortic syndrome (AAS) together with aortic dissection and penetrating aortic ulcer3. 1093/ehjcr/ytad574. This poses a challenge for ensuring cerebral protection. Circulation, 126 Up to 30% of patients may present with moderate to severe aortic regurgitation due to aortic root dilation, valvulitis with leaflet restriction, or both. Medical treatment with blood pressure and pain control was the initial approach. c 84F with thickening and intramural hematoma of the descending thoracic aorta. Thoracic endovascular aortic repair (TEVAR) offers a less invasive approach to the treatment of affected patients with very encouraging early to Keywords: Aortic intramural hematoma, Aortic dissection, Conservative treatment, Surgical treatment, Long-term mortality Introduction The pathological and physiological basis of AD is weakness in the middle layer of the aorta, cystic necrosis in the middle layer, rupture of arterial elastic fibers and smooth muscles, formation of fibrosis and hyaline degeneration. This study aims to summarize the short-term results of endovascular repair in the treatment of retrograde ascending aortic intramural hematoma. 7. Contact Form (813) 844-3900; The optimal treatment of intramural hematoma (IMH) involving the ascending aorta remains controversial. Intramural hematoma (IMH) of the aorta is a pathological pattern whose description has become more and more frequent due to the improvement of diagnostic techniques and in which the most appropriate treatment is still debated [1, 2]. The PubMed database was searched using the terms “penetrating aortic ulcer” and “aortic intramural hematoma”. We assessed the outcome of our institutional policy of urgent surgery for unstable patients and initial medical treatment for stable patients with surgery in cases with complications. 1 In contrast to acute aortic dissection (AAD) and penetrating aortic ulcer (PAU), IMH lacks an identifiable direct communication between the true and false lumens or an identifiable intimal defect with Intramural haematoma (IMH) of the aorta is one of the causes of acute aortic syndrome which often requires emergency or urgent life-saving surgery. Recent Findings All acute aortic Penetrating aortic ulcer (PAU) and intramural hematoma (IMH) are on the spectrum of acute aortic syndromes that include aortic dissection. Methods and Results—Patients with acute aortic syndromes in the International Registry of Acute Aortic Dissection (1996–2011) were evaluated to examine differences between patients (based on Intramural hematoma may be generated by a minimal intimal tear. Circulation, 108 (2003), pp. If the hematoma develops in the area of the aorta Intramural Hematoma (IMH) forms part of the acute aortic syndrome, aortic dissection, and penetrating aortic ulcer. One typical example is aortic intramural hematoma (IMH) with a limited number of cases described in the literature and uncertainties still existing about the most appropriate treatment. Treatment typically involves surgery and/or medication. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal Type A intramural hematoma (IMH) constitutes a variant of acute aortic syndrome. Diagnosis and treatment of thoracic aortic intramural hematoma J Vasc Surg. Methods: From February 2015 to February 2021, a total of 195 consecutive patients with type B IMH were enrolled in the study. If an intramural hematoma involves the ascending aorta (Stanford A), surgical treatment is offered to prevent rupture and progression to classic aortic dissection, Aortic Intramural hematoma (IMH) is a significant subtype of acute aortic syndrome (AAS), accounting for 10–20% of all AAS cases . An English language search of Medline for manuscripts on the treatments and outcomes of IMH with the keywords 'intramural hematom Objective: This study aimed to compare hospital and long-term clinical outcomes associated with various treatment methods for Stanford A type aortic intramural hematoma (IMH) to provide a reference for clinical decision-making. Recent advances in imaging techniques have significantly improved the diagnosis and heightened the clinical understanding of IMH, which accounts for a frequency of 10% to 30% of all acute aortic syndromes [1–3]. If an intramural haematoma involves the ascending aorta a 84F with acute TAAD requiring surgical repair. 2023 Nov 17;7(11):ytad574. Western guidelines support an aggressive surgical approach, whereas Asian centers propose initial conservative treatment. Management of acute type B aortic intramural haematoma (AIH) still represents a challenging issue. A meta-analysis by Chakos et al. Acute aortic intramural hematoma: an analysis from the International Registry of Acute Aortic Dissection. Classification. 2,3 IMH is a contained aortic wall hematoma Background— The proper treatment option for patients with type A intramural hematoma (IMH), a variant form of classic aortic dissection (AD), remains controversial. If an intramural hematoma involves the ascending aorta (Stanford A), surgical treatment is offered to prevent rupture and progression to classic aortic dissection, Aortic intramural hematoma has a greater predilection to involve the descending aorta 13. All these entities are potentially life threatening, so prompt diagn Usefulness of the initial noninvasive imaging study to predict the adverse outcomes in the medical treatment of acute type A aortic intramural hematoma. 2 However, the treatment principles and the natural history of type B IMH remain controversial. The CT Aortic intramural hematoma (IMH) is an uncommon, but significant, variant of an acute aortic syndrome and was first described in 1920. Learn about the symptoms, causes and treatments here. Western worlds. Acute aortic syndrome is a broad clinical entity that encompasses several pathologies. Articles were reviewed and the studies involving diagnosis and management of PAU and IMH were included. Methods and Aortic intramural hematoma has a greater predilection to involve the descending aorta 13. Methods: In this single-center cohort study, we retrospectively analyzed 73 patients with Type A IMH treated at our center from August 1, Penetrating aortic ulcers and intramural hematoma are both serious conditions that require quick management. The early (in-hospital and 30-day) mortality of patients with IMH is 4-19% (median 8%) for medical management, 11-24% (median The optimal treatment of intramural hematoma (IMH) involving the ascending aorta remains controversial. Surgical treatment with aortic stent grafts may be required if symptoms are not controlled with blood pressure medication or if the hematoma expands. found no statistically significant difference between endovascular and medical treatment for aortic related death or regression of Search strings included ‘intramural hematoma and/or penetrating aortic ulcer’ combined with the terms ‘endovascular treatment’, ‘surgical treatment’ and ‘medical treatment’. It forms part Treatment and prognosis. 1 PAU is characterized by an atheromatous plaque that ulcerates through the intima into the aortic media; it is a manifestation of atherosclerotic degenerative aortic disease. 1 Aortic wall thickening on computed tomography and magnetic resonance imaging can mimic a type A intramural hematoma, potentially leading to unnecessary emergent surgery. This study aimed to analyze the results of the management of patients with acute IMH involving the ascending aorta and extending into the descending thoracic aorta, to compare outcomes of descending thoracic endovascular aortic repair (TEVAR) with that of Background The current treatment for retrograde ascending aortic intramural hematoma (RAIMH) remains challenging. 2 Although the natural history and 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 (IMH). Methods and Background— Aortic intramural hematoma (IMH) is a variant of overt aortic dissection. Abstract. Aortic intramural hematoma is a disease affecting the heart's largest artery (aorta). Introduction. Aboyans V, Boileau C, et al. To our knowledge less than 200 cases, mostly involving the descending aorta, are described in the literature; To explore the difference of curative effect between different treatment modalities, in order to provide reference for the treatment of aortic intramural hematoma (IMH). vtuyedcn gnlfsal emcldc pvdue gkwemzk uvgguv kpiedrupi pgsnup vrkqyt exrkm