Jiang Xiaolang, Liu Yifan, Chen Bin, Jiang Junhao, Shi Yun, Ma Tao, Lin Changpo, Guo Daqiao, Xu Xin, Fu Weiguo, Dong Zhihui
Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Vascular. 2022 Apr;30(2):191-198. doi: 10.1177/17085381211012573. Epub 2021 Apr 28.
To identify the differences between clinical features and outcomes after endovascular therapy for penetrating aortic ulcer (PAU) and intramural hematoma (IMH).
From January 2009 to March 2020, patients who underwent endovascular therapy for PAU and IMH were enrolled. Information on patient demographics, presentation, PAU and IMH morphology, laboratory examination, and clinical follow-up information was collected and analyzed. Univariate analysis was performed to identify the differences between IMH and PAU, and Kaplan-Meier was used to calculate the cumulative survival rate and freedom from reintervention.
A total of 114 patients were enrolled; 80 (70.2%) of them were diagnosed with PAU. Compared with PAU, patients with IMH were younger ( = 0.006), more likely to be admitted emergently ( = 0.001), had longer hospital stay ( = 0.028), and had higher levels of C-reactive protein ( = 0.030). Meanwhile, patients with IMH were more likely to be associated with hypertension ( = 0.020) and pleural effusion ( < 0.001) and less likely to have a history of acute coronary syndrome ( = 0.019) and prior cardiovascular intervention ( = 0.017). The five-year freedom from reintervention and cumulative survival rate were 94.2% (95% confidential interval, 88.9%-99.9%) and 87.8% (95% confidential interval, 79.5%-96.9%) in PAU patients and 89.6% (95% confidential interval, 75.8%-99.9%) and 85.1% (95% confidential interval, 68.0%-99.9%) in IMH patients, respectively. There was no significant difference in freedom from reintervention ( = 0.795) or cumulative survival rate ( = 0.817).
IMH appeared to occur in younger patients with hypertension and usually had an acute onset, while PAU was more likely to be found incidentally in older patients with atherosclerosis. Endovascular therapy was effective in both IMH and PAU patients with encouraging outcomes.
确定穿透性主动脉溃疡（PAU）和壁内血肿（IMH）血管内治疗后临床特征和预后的差异。
纳入2009年1月至2020年3月期间接受PAU和IMH血管内治疗的患者。收集并分析患者人口统计学、临床表现、PAU和IMH形态、实验室检查及临床随访信息。进行单因素分析以确定IMH和PAU之间的差异，并采用Kaplan-Meier法计算累积生存率和免于再次干预率。
共纳入114例患者；其中80例（70.2%）诊断为PAU。与PAU患者相比，IMH患者更年轻（P = 0.006），更可能急诊入院（P = 0.001），住院时间更长（P = 0.028），C反应蛋白水平更高（P = 0.030）。同时，IMH患者更易合并高血压（P = 0.020）和胸腔积液（P < 0.001），急性冠状动脉综合征病史（P = 0.019）和既往心血管介入史（P = 0.017）的可能性较小。PAU患者的五年免于再次干预率和累积生存率分别为94.2%（95%置信区间，88.9% - 99.9%）和87.8%（95%置信区间，79.5% - 96.9%），IMH患者分别为89.6%（95%置信区间，75.8% - 99.9%）和85.1%（95%置信区间，68.0% - 99.9%）。免于再次干预率（P = 0.795）或累积生存率（P = 0.817）无显著差异。
IMH似乎发生于更年轻的高血压患者，通常起病急，而PAU更易在患有动脉粥样硬化的老年患者中偶然发现。血管内治疗对IMH和PAU患者均有效，预后令人鼓舞。
