Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists · 2026
Natural History and Impact of Thoracic Endovascular Stent-Grafting on Type B Intramural Hematoma: A World of Caution.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Laurin Charles, Chassé Philippe, Santoire William, Porterie Jean, Abdelli Rim, Dagenais François
Аннотация
OBJECTIVES: Intramural hematoma (IMH) is characterized by an unpredictable natural history. Thoracic endovascular aortic repair (TEVAR) has increasingly been employed as treatment with limited midterm outcomes reported.
METHODS: To better characterize the natural history of type B IMH and TEVAR outcomes, we reviewed our institutional experience. Data were collected prospectively, and patients followed in a dedicated aortic clinic.
RESULTS: Since 2001, 40 patients were treated for type B IMH without focal intimal disruption (FID) on initial computed tomography (CT). All patients were initially treated with optimal blood pressure management, pain control, and control CT within 5 to 7 days. Fourteen patients had TEVAR during the index hospitalization due to the presence of a new FID with progression of the IMH thickness or persistent symptoms. Of the remaining 26 patients, 16 required late TEVAR at a mean of 41.3 ± 112.2 months for type B dissection, new FID, or pseudoaneurysm formation. The remaining 10 patients had complete resolution of the IMH on optimal medical therapy (OMT) alone. Patients in the early TEVAR group developed a significantly higher rate of complication than patients treated in the chronic TEVAR phase (78% vs 38%; P = .003). Patients treated with early and late TEVAR had a 5-year survival of 100% and 64.9%, respectively.Clinical ImpactFavorable outcomes can be achieved with OMT and TEVAR for patients with type B IMH. The TEVAR performed in the acute setting carries a substantial risk of complications, emphasizing the need to optimize the timing of TEVAR and adapt stent-graft design to the pathophysiology of IMH.
METHODS: To better characterize the natural history of type B IMH and TEVAR outcomes, we reviewed our institutional experience. Data were collected prospectively, and patients followed in a dedicated aortic clinic.
RESULTS: Since 2001, 40 patients were treated for type B IMH without focal intimal disruption (FID) on initial computed tomography (CT). All patients were initially treated with optimal blood pressure management, pain control, and control CT within 5 to 7 days. Fourteen patients had TEVAR during the index hospitalization due to the presence of a new FID with progression of the IMH thickness or persistent symptoms. Of the remaining 26 patients, 16 required late TEVAR at a mean of 41.3 ± 112.2 months for type B dissection, new FID, or pseudoaneurysm formation. The remaining 10 patients had complete resolution of the IMH on optimal medical therapy (OMT) alone. Patients in the early TEVAR group developed a significantly higher rate of complication than patients treated in the chronic TEVAR phase (78% vs 38%; P = .003). Patients treated with early and late TEVAR had a 5-year survival of 100% and 64.9%, respectively.Clinical ImpactFavorable outcomes can be achieved with OMT and TEVAR for patients with type B IMH. The TEVAR performed in the acute setting carries a substantial risk of complications, emphasizing the need to optimize the timing of TEVAR and adapt stent-graft design to the pathophysiology of IMH.