Department of Vascular Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China.
J Endovasc Ther. 2010 Oct;17(5):617-21. doi: 10.1583/10-3125.1a.
To report a prospective study that explored the therapeutic strategies in the treatment of type B aortic intramural hematoma (IMH) and evaluated the role of endovascular repair.
Between January 2001 and December 2009, 56 consecutive patients were enrolled in a prospective study to evaluate stent-graft repair versus medical therapy for acute type B IMH (patients with type A IMH excluded). Patients who had penetrating atherosclerotic ulcers, maximum aortic diameter >45 mm, hematoma thickness >10 mm, or sustained chest or back pain despite maximal medical therapy received endovascular stent-grafts (n=33; mean age 60 years, range 33-86), while other patients (n=23; mean age 56 years, range 29-83) received conservative therapy.
Stent-grafts were implanted successfully as scheduled in 33 patients as elective procedures; there were no complications related to the procedure. The mean follow-up up was 28±15 months (range 3-108). In the medically treated patients, there were 6 (26%) cases of IMH progression (4 treated with stent-grafts) and 2 (9%) deaths versus no IMH progression or death in the stent-graft patients. The thickness of the hematoma was reduced in all 37 patients receiving stent-grafts, and the maximum aortic diameter decreased in 19 of these patients. The 17 surviving patients in the medical group also showed regression of the hematoma in follow-up.
Type B IMH is a potentially lethal disease, and the application of endovascular stent-grafts achieved an encouraging result in this study. Therefore, a more optimistic strategy, including endovascular repair, should be considered and evaluated in the future.
报告一项前瞻性研究，该研究探讨了 B 型主动脉壁内血肿（IMH）的治疗策略，并评估了血管内修复的作用。
2001 年 1 月至 2009 年 12 月，56 例连续患者参与了一项前瞻性研究，以评估支架型移植物修复与急性 B 型 IMH 的药物治疗（排除 A 型 IMH 患者）。对于穿透性粥样硬化性溃疡、最大主动脉直径>45mm、血肿厚度>10mm 或尽管接受最大药物治疗仍持续胸痛或背痛的患者，接受血管内支架型移植物（n=33；平均年龄 60 岁，范围 33-86），而其他患者（n=23；平均年龄 56 岁，范围 29-83）接受保守治疗。
33 例患者作为择期手术成功植入支架型移植物，无与手术相关的并发症。中位随访时间为 28±15 个月（范围 3-108）。在药物治疗的患者中，有 6 例（26%）IMH 进展（4 例接受支架型移植物治疗）和 2 例（9%）死亡，而支架型移植物患者无 IMH 进展或死亡。所有接受支架型移植物治疗的 37 例患者的血肿厚度均减少，其中 19 例患者的最大主动脉直径减小。在药物治疗组中存活的 17 例患者在随访中也显示血肿消退。
B 型 IMH 是一种潜在致命的疾病，血管内支架型移植物的应用在本研究中取得了令人鼓舞的结果。因此，未来应考虑并评估更乐观的策略，包括血管内修复。
