Modugno Pietro, Centritto Enrico Maria, Amatuzio Mariangela, Testa Nicola, Grimani Vittorio, Cilla Savino, Pierro Antonio, De Filippo Carlo Maria
Vascular Surgery Unit, Fondazione di ricerca e cura 'Giovanni Paolo II', Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
Cardiac Surgery Unit, Fondazione di ricerca e cura 'Giovanni Paolo II', Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
SAGE Open Med Case Rep. 2021 Jan 9;9:2050313X20983207. doi: 10.1177/2050313X20983207. eCollection 2021.
We reported four cases of intramural haematoma of the descending thoracic aorta. Four patients, aged 55-82 years, hypertensive, were transferred from the emergency room of other hospitals due to the appearance of epigastric pain and left thorax pain. All patients underwent computed tomography angiography reporting the presence of intramural haematoma. Three patients underwent a drug therapy to maintain a controlled hypotension. A computed tomography revaluation was performed documenting (1) an increase in the thickness of the intramural haematoma, (2) the appearance of a penetrating ulcer within the haematoma and (3) the appearance of several penetrating lesions throughout the thoracic aorta. Patients required the placement of one or two thoracic aorta endoprosthesis. For the fourth patient, the hyperdense appearance of the intramural haematoma and the presence of pleural effusion suggested an urgent treatment intervention. All patients underwent a placement of cerebrospinal fluid catheter and drainage before treatment. All patients were treated with endovascular intervention with 100% technical success and absence of migration or retrograde type A dissection. There were no complications related to femoral surgical access or access routes. Perioperative mortality was null; no patient had paraplegia. No strokes, transient ischemic attack or perioperative myocardial infarction were observed. The average hospitalization was 5 days. After 3 months, angio-computed tomography reported for all patients a complete reabsorption of the intramural haematoma and a complete exclusion of the penetrating ulcer of the aortic wall present at the time of the intervention. There have been no cases of distant thoracic aortic tears. Endovascular treatment must be considered the preeminent treatment for thoracic aortic haematoma. Best timing to perform the endovascular procedure depends on the patient clinical picture and on stability of hemodynamic parameters.
我们报告了4例胸降主动脉壁内血肿病例。4例患者年龄在55 - 82岁之间，均为高血压患者，因出现上腹部疼痛和左胸痛从其他医院急诊室转诊而来。所有患者均接受了计算机断层血管造影，结果显示存在壁内血肿。3例患者接受了药物治疗以维持控制性低血压。进行了计算机断层扫描复查，结果显示：（1）壁内血肿厚度增加；（2）血肿内出现穿透性溃疡；（3）整个胸主动脉出现多处穿透性病变。患者需要植入一或两个胸主动脉内支架。对于第4例患者，壁内血肿的高密度表现及胸腔积液提示需要紧急治疗干预。所有患者在治疗前均放置了脑脊液导管并进行引流。所有患者均接受了血管内介入治疗，技术成功率达100%，且未出现移位或逆行性A型夹层。未发生与股动脉手术入路或通路相关的并发症。围手术期死亡率为零；无患者发生截瘫。未观察到中风、短暂性脑缺血发作或围手术期心肌梗死。平均住院时间为5天。3个月后，血管计算机断层扫描显示所有患者壁内血肿完全吸收，干预时存在的主动脉壁穿透性溃疡完全排除。未发生远处胸主动脉撕裂病例。血管内治疗应被视为胸主动脉血肿的首要治疗方法。进行血管内手术的最佳时机取决于患者的临床表现和血流动力学参数的稳定性。
