Preliminary Study Of Clinical Efficacy Of Aortic Intramural Hematoma

Objective:To summarize and analyze the data of conservative treatment and endovascular treatment of aortic intramural hematoma,and to explore the difference of curative effect between different treatment modalities,so as to provide reference for the treatment of aortic intramural hematoma.Methods:56 patients with IMH diagnosed and treated from January 2012 to December2016 were selected in the Second Affiliated Hospital of Nanchang University.Among them,16 cases were Stanford A IMH,40 patients with Stanford B IMH.According to the therapeutic methods,patients were divided into conservative treatment group and endovascular treatment group(TEVAR).For endovascular treatment group,according to the different timing of surgery,can be divided into acute phase group(onset within 72h)and non acute phase group(time of onset >72h).The clinical data and follow-up data were collected and analyzed by variance analysis and ?2 test.Results:56 cases of IMH patients,13 cases(90%)with Stanford A IMH patients with pleural or pericardial effusion.14 cases(35%)with Stanford A IMH patients with pleural or pericardial effusion.16 cases were stanford A IMH(28.6%),Endovascular treatment was performed in 5 patients(31.2%),and 11 cases(68.8%)were treated with conservative treatment,The average follow-up(24.9±13.9)months.There were 5 patients in the Endovascular treatment group,the CTA showed the maximum aortic diameter ?50mm or hematoma thickness ?11mm:3 cases of patients in acute operation group,no endoleak in the postoperative,during the follow-up period,the hematoma decreased or absorbed;2cases of patients in the non acute operation group,preoperative CTA examination showed progression to aortic dissection,Postoperative type I endoleak occurred in 1cases,followed up observation in December,the endoleak disappeared,and the other one had no endoleak and hematoma absorption.The conservative treatment group of11 cases,admission CTA maximum aortic diameter ?50mm or hematoma thickness?11mm in 7 cases,Among them,1 patients died during the period of hospitalization,1 cases died during the follow-up period,4 cases progression to aortic dissection,and1 cases had no change after CTA examination;4 cases were CTA maximum aortic diameter <50mm and the thickness of hematoma <11mm,follow-up showed reduced or hematoma absorption.There were 40 patients with Stanford type IMH(71.4%),20 patients received endovascular treatment(50%),and 20 patients(50%)received conservative treatment,with an average follow-up(27.8±14.6)months.9 patients in acute operation group,The admission CTA maximum aortic diameter ?40mm or hematoma thickness ?10mm in 6 cases,type I endoleak occurred in 2 cases after operation,and all the endoleak disappeared within 6~12 months after the follow-up.The remaining 4patients were hematoma less or absorbed during the follow-up period;The admission CTA maximum aortic diameter<40mm and the thickness of hematoma <10mm in 3cases,There was no endoleak after the operation,The hematoma was less or absorbed during the follow-up period.11 cases of patients in non acute operation group,including admission CTA maximum aortic diameter ?40mm or hematoma thickness?10mm in 6 patients,And preoperative CTA showed aortic dissection.no endoleak after operation.The hematoma in the follow-up period was decreased or absorbed;5cases were CTA maximum aortic diameter <40mm and the thickness of hematoma<10mm,There was no endoleak after the follow-up,and the hematoma decreased or absorbed during the follow-up period.20 cases of conservative treatment,admission CTA maximum aortic diameter ?40mm or hematoma thickness ?10mm patients with10 cases,Cerebral infarction death occurred in 1 cases during hospitalization,in 1cases of unexplained death outside the hospital,in 6 cases of aortic dissection,left lower extremity arterial thrombosis in 1 cases,1 cases had no hematoma changes;the maximum aortic diameter <40mm and the thickness of hematoma <10mm in 10 patients,The hematoma was decreased or absorbed during the follow-up period.Stanford A type IMH patients when the maximum aortic diameter ?50mm or hematoma thickness ?11mm,with high morbidity and mortality,positive endovascular treatment can reduce complications and death.Patients with Stanfordtype B IMH,when the maximum aortic diameter ?40mm or hematoma thickness?10mm,with high morbidity and mortality,positive endovascular treatment can reduce complications and death.Conclusion:Stanford A type IMH patients are more complicated with pleural or pericardial effusions.Stanford A type IMH patients the initial maximum aortic diameter ?50mm or hematoma thickness ?11mm,the more vulnerable to complications or death,endovascular treatment is recommended actively.Stanford B type IMH patients the initial maximum aortic diameter ?40mm or hematoma thickness ?10mm,the more vulnerable to complications or death,endovascular treatment is recommended actively.