Retrospective Analysis Of 123 Stanford B Intramural Hematoma

BackgroundStanford type B intramural hematoma(IMHB) is a kind of severe life-threatening disease. With the advances of imaging techniques, IMHB has got much more attention in clinicians. To anticipate the clinical prognosis and select an optimal therapy makes a great difference in IMH patients. ObjectiveReview the clinical manifestation, imaging features, treatments and follow-up information of IMHB patients, explore the prognosis and clinical outcomes of IMH. MethodsRetrospective analyze 123 IMHB patients admitted to Wuhan Union Hospital from January 2008 to January 2015, all patients were collected integral information from medical records and follow-up records. Patients were divides into two categories according to whether IMHB were associated with ulcer-like projections(ULPs) or not. Comparison was made between the two groups among clinical manifestation, imaging features, treatments and prognosis, and collected the information in IMH patients associated with ULPs with different clinical outcomes, and screen out the risk factor associated with diffident clinical outcomes. ResultsThere were 75 patients with IMHB coexisted with ULPs(group 1) and 74 patients unaccompanied by ULPs(group 2). The patients in group 1 was slightly older than group 2(p=0.038), with a higher incidence of non-typical symptoms. The hematoma of the affected aorta is thicker in group 1(p=0.02), along with ratio between the thickness of hematoma and the diameter of the affected aortic(p=0.03). There was no difference in mortality of conservative therapy between the two groups(7.46%vs4.35%, p=0.37). No patients died of IMH progression in the two groups treated by endovascular therapy, with a mortality of 5% in group 1. Between 3-37 months after the onset of IMH, 97 patients has a complete absorption or almost adsorbed, with another 26 patients obvious tendency to absorption. 6 patients progressed to aortic aneurysm accompanied as well as 9 patients progressed to aortic dissection in group 1, which has an correlation with existed ULPs or new-found, among them, 3 patients died. The clinical outcome of group 2 was much better than group 1(p=0.008) which has 3 progressed patients. ULPs disappeared in 7 patients and 14 patients enlarge in diameter, together with new-found ULPs were observed in 8 patients. All of the ULPs disappeared covered by stent, the endovascular therapy has a distinct better outcome than conservative therapy(p<0.0001).Uncontrollable pain was a risk factors that predict a disease progression(p<0.0001). ConclusionULPs is a stimulant of hematoma thickening, though with tiny influences on the overall tendency of absorption of intramural hematoma. ULPs do not affect the mortality in IMHB patients, but have obvious correlation on the occurrence of complications such as aortic aneurysm and aortic dissection, and uncontrolled pain often heralds a poor clinical outcome. Endovascular therapy is a safe and effective treatment, and has advantages than conservative therapy in the treatment of IMHB with ULPs.