Is medical management of Type A intramural hematomas and penetrating aortic ulcers a feasible treatment modality?

摘要

Answer: No. Review of available literature reveals variable outcomes with initial medical management of these types of lesions, particularly intramural hematomas, as 27-96% of medically managed patients with intramural hematomas eventually experience adverse events or require emergency surgical intervention. In 2009, Song et. al reported 84% of patients at their facility with intramural hematomas treated medically had lower in-hospital mortality than similar patients with aortic dissection and equivalent mortality rates to patients with intramural hematoma that were surgically treated.1 Unfortunately, one-third of these medically treated patients progressed to aortic dissection, rupture or aneurysmal degeneration requiring surgical intervention. The subset of subsequently published literature available reveals that aortic intervention is required in approximately 40% of medically managed patients at three years. Given this data, patients with intramural hematomas should be treated similarly to those with aortic dissection in a corresponding location, specifically Type A lesions should be treated with early and aggressive surgical intervention. Patients with penetrating aortic ulcers who are symptomatic or in cases of radiographically proven expansion or contained rupture should undergo definitive treatmentto prevent intramural hematoma formation or progression to aortic dissection.