Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX.
Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX.
Ann Vasc Surg. 2023 Aug;94:14-21. doi: 10.1016/j.avsg.2022.09.041. Epub 2022 Oct 26.
Intramural hematoma (IMH) is one of the acute aortic syndromes along with acute aortic dissection and penetrating aortic ulcer. The three conditions can occur alone or in combination with overlapping presentation. Medical, open surgical, and endovascular treatment is tailored depending on clinical presentation, timing, and location within the aorta. Among patients who present with acute IMH affecting the ascending aorta (Type A), urgent open surgical repair is considered the primary line of treatment in patients who are suitable candidates and unstable. The management of IMH in the descending aorta and aortic arch (Type B) is similar to that applied to treat acute dissections in the same segment. Medical treatment with sequential imaging is recommended in patients with uncomplicated course, and endovascular repair is indicated in patients with rupture, persistent pain, end-organ ischemia, or rapid aortic enlargement. This review discusses the ideal timing for treatment of IMH.
壁内血肿（IMH）是急性主动脉综合征之一，其他两种分别为急性主动脉夹层和穿透性主动脉溃疡。这三种情况可单独发生，也可合并重叠表现。根据临床表现、时机和主动脉内位置，可采用内科、开放性手术和血管内治疗。急性壁内血肿影响升主动脉（A型）的患者中，适合手术且不稳定的患者，紧急开放性手术修复被认为是主要治疗方法。降主动脉和主动脉弓（B 型）壁内血肿的处理与同一节段急性夹层的治疗方法相似。对于病情无并发症的患者，推荐进行连续影像学检查的内科治疗，对于破裂、持续疼痛、终末器官缺血或主动脉快速扩大的患者，则推荐血管内修复。本文讨论了 IMH 的理想治疗时机。
