Acute intramural hematoma of the aorta

A mystery in evolution

Arturo Evangelista, Debabrata Mukherjee, Rajendra H. Mehta, Patrick T. O'Gara, Rossella Fattori, Jeanna V. Cooper, Dean E. Smith, Jae Kuen Oh, Stuart Hutchison, Udo Sechtem, Eric M. Isselbacher, Christoph A. Nienaber, Linda A. Pape, Kim A. Eagle

Research output: Contribution to journalArticle

306 Citations (Scopus)

Abstract

Background - The definition, prevalence, outcomes, and appropriate treatment strategies for acute intramural hematoma (IMH) continue to be debated. Methods and Results - We studied 1010 patients with acute aortic syndromes who were enrolled in the International Registry of Aortic Dissection (IRAD) to delineate the prevalence, presentation, management, and outcomes of acute IMH by comparing these patients with those with classic aortic dissection (AD). Fifty-eight (5.7%) patients had IMH, and this cohort tended to be older (68.7 versus 61.7 years; P<0.001) and more likely to have distal aortic involvement (60.3% versus 35.3%; P<0.001) compared with 952 patients with AD. Patients with IMH described more severe initial pain than did those with AD but were less likely to have ischemic leg pain, pulse deficits, or aortic valve insufficiency; moreover, they required a longer time to diagnosis and more diagnostic tests. Overall mortality of IMH was similar to that of classic AD (20.7% versus 23.9%; P=0.57), as was mortality in patients with IMH of the descending aorta (8.3% versus 13.1%; P=0.60) and the ascending aorta (39.1% versus 29.9%; P=0.34) compared with AD. IMH limited to the aortic arch was seen in 7 patients, with no deaths, despite medical therapy in only 6 of the 7 individuals. Among the 51 patients whose initial diagnostic study showed IMH only, 8 (16%) progressed to AD on a serial imaging study. Conclusions - The IRAD data demonstrate a 5.7% prevalence of IMH in patients with acute aortic syndromes. Like classic AD, IMH is a highly lethal condition when it involves the ascending aorta and surgical therapy should be considered, but this condition is less critical when limited to the arch or descending aorta. Fully 16% of patients have evidence of evolution to dissection on serial imaging.

Original languageEnglish (US)
Pages (from-to)1063-1070
Number of pages8
JournalCirculation
Volume111
Issue number8
DOIs
StatePublished - Mar 1 2005

Fingerprint

Hematoma
Aorta
Dissection
Thoracic Aorta
Registries
Pain
Aortic Valve Insufficiency
Mortality
Routine Diagnostic Tests
Pulse
Leg
Therapeutics

Keywords

  • Aorta
  • Hemorrhage
  • Mortality
  • Statistics

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Evangelista, A., Mukherjee, D., Mehta, R. H., O'Gara, P. T., Fattori, R., Cooper, J. V., ... Eagle, K. A. (2005). Acute intramural hematoma of the aorta: A mystery in evolution. Circulation, 111(8), 1063-1070. https://doi.org/10.1161/01.CIR.0000156444.26393.80

Acute intramural hematoma of the aorta : A mystery in evolution. / Evangelista, Arturo; Mukherjee, Debabrata; Mehta, Rajendra H.; O'Gara, Patrick T.; Fattori, Rossella; Cooper, Jeanna V.; Smith, Dean E.; Oh, Jae Kuen; Hutchison, Stuart; Sechtem, Udo; Isselbacher, Eric M.; Nienaber, Christoph A.; Pape, Linda A.; Eagle, Kim A.

In: Circulation, Vol. 111, No. 8, 01.03.2005, p. 1063-1070.

Research output: Contribution to journalArticle

Evangelista, A, Mukherjee, D, Mehta, RH, O'Gara, PT, Fattori, R, Cooper, JV, Smith, DE, Oh, JK, Hutchison, S, Sechtem, U, Isselbacher, EM, Nienaber, CA, Pape, LA & Eagle, KA 2005, 'Acute intramural hematoma of the aorta: A mystery in evolution', Circulation, vol. 111, no. 8, pp. 1063-1070. https://doi.org/10.1161/01.CIR.0000156444.26393.80
Evangelista A, Mukherjee D, Mehta RH, O'Gara PT, Fattori R, Cooper JV et al. Acute intramural hematoma of the aorta: A mystery in evolution. Circulation. 2005 Mar 1;111(8):1063-1070. https://doi.org/10.1161/01.CIR.0000156444.26393.80
Evangelista, Arturo ; Mukherjee, Debabrata ; Mehta, Rajendra H. ; O'Gara, Patrick T. ; Fattori, Rossella ; Cooper, Jeanna V. ; Smith, Dean E. ; Oh, Jae Kuen ; Hutchison, Stuart ; Sechtem, Udo ; Isselbacher, Eric M. ; Nienaber, Christoph A. ; Pape, Linda A. ; Eagle, Kim A. / Acute intramural hematoma of the aorta : A mystery in evolution. In: Circulation. 2005 ; Vol. 111, No. 8. pp. 1063-1070.
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abstract = "Background - The definition, prevalence, outcomes, and appropriate treatment strategies for acute intramural hematoma (IMH) continue to be debated. Methods and Results - We studied 1010 patients with acute aortic syndromes who were enrolled in the International Registry of Aortic Dissection (IRAD) to delineate the prevalence, presentation, management, and outcomes of acute IMH by comparing these patients with those with classic aortic dissection (AD). Fifty-eight (5.7{\%}) patients had IMH, and this cohort tended to be older (68.7 versus 61.7 years; P<0.001) and more likely to have distal aortic involvement (60.3{\%} versus 35.3{\%}; P<0.001) compared with 952 patients with AD. Patients with IMH described more severe initial pain than did those with AD but were less likely to have ischemic leg pain, pulse deficits, or aortic valve insufficiency; moreover, they required a longer time to diagnosis and more diagnostic tests. Overall mortality of IMH was similar to that of classic AD (20.7{\%} versus 23.9{\%}; P=0.57), as was mortality in patients with IMH of the descending aorta (8.3{\%} versus 13.1{\%}; P=0.60) and the ascending aorta (39.1{\%} versus 29.9{\%}; P=0.34) compared with AD. IMH limited to the aortic arch was seen in 7 patients, with no deaths, despite medical therapy in only 6 of the 7 individuals. Among the 51 patients whose initial diagnostic study showed IMH only, 8 (16{\%}) progressed to AD on a serial imaging study. Conclusions - The IRAD data demonstrate a 5.7{\%} prevalence of IMH in patients with acute aortic syndromes. Like classic AD, IMH is a highly lethal condition when it involves the ascending aorta and surgical therapy should be considered, but this condition is less critical when limited to the arch or descending aorta. Fully 16{\%} of patients have evidence of evolution to dissection on serial imaging.",
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