Evangelista Arturo, Mukherjee Debabrata, Mehta Rajendra H, O'Gara Patrick T, Fattori Rossella, Cooper Jeanna V, Smith Dean E, Oh Jae K, Hutchison Stuart, Sechtem Udo, Isselbacher Eric M, Nienaber Christoph A, Pape Linda A, Eagle Kim A
Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
Circulation. 2005 Mar 1;111(8):1063-70. doi: 10.1161/01.CIR.0000156444.26393.80. Epub 2005 Feb 14.
The definition, prevalence, outcomes, and appropriate treatment strategies for acute intramural hematoma (IMH) continue to be debated.
We studied 1010 patients with acute aortic syndromes who were enrolled in the International Registry of Aortic Dissection (IRAD) to delineate the prevalence, presentation, management, and outcomes of acute IMH by comparing these patients with those with classic aortic dissection (AD). Fifty-eight (5.7%) patients had IMH, and this cohort tended to be older (68.7 versus 61.7 years; P<0.001) and more likely to have distal aortic involvement (60.3% versus 35.3%; P<0.001) compared with 952 patients with AD. Patients with IMH described more severe initial pain than did those with AD but were less likely to have ischemic leg pain, pulse deficits, or aortic valve insufficiency; moreover, they required a longer time to diagnosis and more diagnostic tests. Overall mortality of IMH was similar to that of classic AD (20.7% versus 23.9%; P=0.57), as was mortality in patients with IMH of the descending aorta (8.3% versus 13.1%; P=0.60) and the ascending aorta (39.1% versus 29.9%; P=0.34) compared with AD. IMH limited to the aortic arch was seen in 7 patients, with no deaths, despite medical therapy in only 6 of the 7 individuals. Among the 51 patients whose initial diagnostic study showed IMH only, 8 (16%) progressed to AD on a serial imaging study.
The IRAD data demonstrate a 5.7% prevalence of IMH in patients with acute aortic syndromes. Like classic AD, IMH is a highly lethal condition when it involves the ascending aorta and surgical therapy should be considered, but this condition is less critical when limited to the arch or descending aorta. Fully 16% of patients have evidence of evolution to dissection on serial imaging.
急性壁内血肿（IMH）的定义、患病率、预后及合适的治疗策略仍存在争议。
我们研究了1010例纳入国际主动脉夹层注册研究（IRAD）的急性主动脉综合征患者，通过将这些患者与经典主动脉夹层（AD）患者进行比较，来明确急性IMH的患病率、表现、治疗及预后。58例（5.7%）患者患有IMH，与952例AD患者相比，该队列患者年龄更大（68.7岁对61.7岁；P<0.001），且更易出现主动脉远端受累（60.3%对35.3%；P<0.001）。与AD患者相比，IMH患者初始疼痛更严重，但出现下肢缺血性疼痛、脉搏缺损或主动脉瓣关闭不全的可能性较小；此外，他们确诊所需时间更长，需要更多的诊断检查。IMH的总体死亡率与经典AD相似（20.7%对23.9%；P=0.57），降主动脉IMH患者的死亡率与AD患者相比也相似（8.3%对13.1%；P=0.60），升主动脉IMH患者的死亡率与AD患者相比同样相似（39.1%对29.9%；P=0.34）。7例患者的IMH局限于主动脉弓，无一例死亡，尽管7例中仅6例接受了药物治疗。在51例初始诊断检查仅显示IMH的患者中，8例（16%）在系列影像学检查中进展为AD。
IRAD数据显示急性主动脉综合征患者中IMH的患病率为5.7%。与经典AD一样，IMH累及升主动脉时是一种高致死性疾病，应考虑手术治疗，但局限于主动脉弓或降主动脉时病情不太严重。完全有16%的患者在系列影像学检查中有演变为夹层的证据。
