Speciality Endovascular Techniques
Library of the School of Health Sciences

2016-06-14

2016

Μπουμπούλης Νικόλαος

Καθ. Γερουλάκος Γ., Αν. Καθ. Κακίσης Ι., Αν. Καθ. Κλωνάρης Χρ.

Διατοιχωματικό αιμάτωμα, έλκος κατιούσης θωρακικής αορτής

English

Intramular haematoma, ulcer of descending thoracic aorta

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. Recent insights provided by modern
high-resolution imaging e.g computed tomography angiography (CTA), are
currently challenging previous pathophysiologic concepts underlying IMH and
PAU, suggesting a close relationship of both entities.
IMH represents a subtype of aortic dissection characterized by crescentic
thickening of the aortic wall and the absence of an intimal flap or visualized
entry point. PAUs is defined as the ulceration of atherosclerotic plaque
through the internal elastic lamina into the aortic media. However, the
presentation, treatment indications, and natural history of this disease
process remain unclear.
Patients with IMH share the same risk profile as those with typical aortic
dissection though tend to be of older age. The symptoms are also similar to
acute aortic dissection, including acute chest and back pain. Mortality for IMH
in a large meta-analysis was 14 %, regardless of management.
The majority of patients are treated with an initial medical approach, which is
successful in the vast majority of patients. Certain patient groups may be at
increased risk for progression to typical aortic dissection or rupture. Risks
for progression of IMH include greater size of the aorta (i.e., 5 cm), presence
of penetrating ulcers, Marfan syndrome, absence of beta–blockade, pleural
effusions and persistent pain. Open surgical repair is utilized infrequently in
type B IMH and reserved for complicated cases.
Regarding patients with PAU, decision between the conservative, surgical or
endovascular mode of treatment is a common dilemma. The presence of
co-morbidities and the side of PAU are the most important determinants of
decision.
In the current era, endovascular stent grafting would be the treatment of
choice for symptomatic patients. Care should be taken to cover all potential
areas of intimal communication by the stent graft.
Thoracic endovascular aortic repair (TEVAR) offers a less invasive approach to
the treatment of affected patients with very encouraging early to midterm
results.

Aortic intramural hematoma, Penetrating aortic ulcer, Aortic dissection, TEVAR, Surgery

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Yes

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https://pergamos.lib.uoa.gr/uoa/dl/object/1310595