Clinical Analysis Of Acute Type A Intramural Hematoma Involving The Descending Aorta

Objective: The optimal treatment of type A intramural hematoma(IMH)remains controversial.This study aimed to analyze the results of the management of acute type A IMH involving the descending aorta,to compare clinical outcomes of descending thoracic endovascular aortic repair(TEVAR)with that of medical therapy(MT),and to assess the risk factors associated with adverse aortic events.Methods: We retrospectively analyzed all patients diagnosed with acute type A IMH involving the descending aorta from January 2012 to December 2019.The primary end-points during follow-up were aortic disease-related death and adverse aorta-related events that required surgical or endovascular treatment,such as aortic rupture,the progression of aortic disease,or endoleak.Results: We identified a total of 135 patients with acute type A IMH involving the descending aorta,of whom 104 underwent descending TEVAR(group 1)and 31 were managed with MT(group 2).Freedom from adverse aorta-related events at 1,3,and 5years was significantly higher for patients who underwent descending TEVAR compared with those managed with medical therapy(89.2%,88.2%,and 84.0% vs74.2%,74.2%,and 74.2% [P=0.026],respectively).The 1-,3-and 5-year survival rates for patients in the descending TEVAR group was 100%,100%,100%,respectively,which was significantly higher than the survival of the MT group: 93.5%,93.5%,and 81.9%,respectively(P=0.002).On a univariate analysis among patients receiving medical treatment,those who suffered adverse aorta-related events showed a higher prevalence of renal insufficiency(55.6% versus 9.1%;P=0.003).In medically treated patients,multivariate analysis showed that renal insufficiency was the only independent risk factor associated with adverse aorta-related events(hazard ratio [HR] = 8.691;95% confidence interval [CI],2.056-36.737;P = 0.003).Conclusions: Based on our study,compared to medical therapy,descending TEVAR might be the more favorable treatment for patients with type A IMH involving the descending aorta.In the medical group,patients with renal insufficiency are more likely to experience adverse aorta-related events,which implies the need for subsequent intervention or an increased risk of mortality.The risk factor would be helpful for clinical decision-making.