Clinical Analysis Of 45 Cases Of Stanford Type B Aortic Intramural Hematoma

Objective: To summarize the therapeutic experience and the clinical data of Stanford type B aortic intracranial hematoma.Methods:The study retrospectively analyzed all clinical data of 45 IMH patients diagnosed by CTA from January 2015 to December 2016 in the Second Hospital of Hebei Medical University.Results: There were 26 cases treated by thoracic aortic endovascular repair(TEVAR),of which 20 cases were initially found the descended contrast agent filling in the aortic arch by imaging data,then did TEVAR treatment after preoperative preparation;meanwhile 5 cases were found the descended contrast agent filling shadow in the aortic arch by reexamining CTA after one week conservative treatment and did the TEVAR;and 1 case progress to Stanford B aortic dissection after one week conservative treatment found by reexamination of CTA and did the TEVAR;Moreover,13 patients had complications,including 3 cases with small amount of pericardial effusion,6 cases with small amount of pleural effusion,2 cases with partial pulmonary dilatation,and 2 cases with both small amount of pleural effusion and partial pulmonary dilatation.During the follow-up of TEVAR,none of the above patients died and the complications disappeared.The intramural hematoma was basically absorbed in 23 patients,and the contrast agent filling shadow in the descending aorta was disappeared in 25 patients.One case of intramural hematoma progressed to dissection in patients with false lumen closure and hematoma absorption after TEVAR.Another one patient appears local dissection found by CTA.On the other hand,19 patients were treated with conservative treatment.Among them,there were 9 cases of contrast-enhancing contrast in thoracic descending aorta.There were 4 complications in total,including a small amount of pericardial effusion in 1 case,a small amount of pleural effusion in 2 cases,and partial lung inflated insufficiency in 1 case.None of the patients died in hospital and during the follow-up period.All the complications were disappeared.During the follow-up period,14 patients with intracerebral hematoma were nearly absorbed by conservative treatment,while only 1 patient with disappearance of contrast agent disappeared in the descending arch,and 2 patients had increased contrast agent filling.There were 2 patients with newly appeared contrast agent filling in descending part of aortic arch.Conclusion:Thoracic aortic endovascular repair have achieved good results in the absorption of aortic hematoma and the regression of complications.Thoracic aortic endovascular repair has significant advantages in the treatment of penetrating ulcers and ulcer-like protrusions in the descending portion of the aortic arch compared to conservative medications.Non-complexity Stanford type B aortic intramural hematoma should be closely screened for conservative treatment.When the symptoms without alleviation or if there is a tendency to rupture,it should be treated promptly with TEVAR.