Long-term follow-up of aortic intramural hematoma: predictors of outcome

• Published in: Circulation (New York, N.Y.) N.Y.), 2003-08, Vol.108 (5), p.583-589
• Main Authors: Evangelista, Arturo, Dominguez, Rosa, Sebastia, Carmen, Salas, Armando, Permanyer-Miralda, Gaieta, Avegliano, Gustavo, Elorz, Cristina, Gonzalez-Alujas, Teresa, Garcia Del Castillo, Herminio, Soler-Soler, Jordi
• Format: Article
• Language: English
• Subjects: Aneurysm, Dissecting - etiology; Aneurysm, False - etiology; Aortic Aneurysm - classification; Aortic Aneurysm - etiology; Aortic Diseases - complications; Aortic Diseases - diagnosis; Disease Progression; Echocardiography, Transesophageal; Female; Follow-Up Studies; Hematoma - complications; Hematoma - diagnosis; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Predictive Value of Tests; Prognosis; Prospective Studies; Remission, Spontaneous; Time; Tomography, X-Ray Computed; Vascular Patency
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.0000081776.49923.5A

Aortic intramural hematoma (IMH) evolves very dynamically in the short-term to regression, dissection, or aortic rupture. The aim of the present study was to assess the long-term clinical and morphological evolution of medically treated IMH. Fifty of 68 consecutive patients with aortic IMH monitored clinically and by imaging techniques at 3, 6, and 12 months and annually thereafter were prospectively studied. Mean follow-up was 45+/-31 months. In the first 6 months, total IMH regression was observed in 14 and progression to aortic dissection in 18 patients; in 14 of these, the dissection was localized, and 12 later developed pseudoaneurysm. At the end of follow-up, the IMH had regressed completely without dilatation in 17 patients (34%), progressed to classical dissection in 6 (12%), evolved to fusiform aneurysm in 11 (22%), evolved to saccular aneurysm in 4 (8%), and evolved to pseudoaneurysm in 12 (24%). Evolution to dissection was related to echolucency (P