Annals of vascular surgery · 2025
Comparative Outcomes of Acute Type B Aortic Dissection and Intramural Hematoma: Implications for Surgical and Endovascular Management.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Jeon Byeng Hun, Yoon Tae Hong, Kim Kyung Ho, Lee Chul Ho, Jang Jae Seok, Cho Jun Woo
Аннотация
BACKGROUND: Acute type B aortic syndrome (ATBAS), including type B aortic dissection (AD) and intramural hematoma (IMH), shares management guidelines; however, their natural history may differ. Comparative single-center data are limited.
METHODS: We retrospectively reviewed 131 patients with ATBAS (52 with AD and 79 with IMH) treated from 2008 to 2025. Patients were stratified into interventional (thoracic endovascular aortic repair [TEVAR]) and medical groups. Serial computed tomography at 3 thoracic levels was performed using standardized protocols, with aortic growth assessed by smoothing and mixed-effects regression.
RESULTS: Patients with IMH were older than those with AD (70.6 ± 12.3 vs. 60.5 ± 16.1 years; P = 0.0002), with modest early TEVAR rates (28.8% vs. 24.1%). Among medically managed patients, delayed intervention occurred in 13.5% and 6.7% of patients with AD and IMH. Indications differed: progressive enlargement in AD and heterogeneous causes in IMH. Mean time to intervention was longer in patients with AD (18.5 months; 3.2 months excluding one outlier) than in those with IMH (3.0 months). TEVAR promoted favorable remodeling in both diseases but did not improve survival. IMH prevalence was higher than that in Western cohorts, aligning with Asian data. Changes in the aortic diameter were strongly linked to false lumen thickness in AD and hematoma thickness in IMH.
CONCLUSION: Despite similar guidelines, AD and IMH exhibit distinct remodeling patterns. Conservative therapy remains effective in selected uncomplicated cases, whereas TEVAR improves remodeling without a survival benefit. Progressive enlargement in uncomplicated AD suggests that performing TEVAR in early stages is beneficial.
METHODS: We retrospectively reviewed 131 patients with ATBAS (52 with AD and 79 with IMH) treated from 2008 to 2025. Patients were stratified into interventional (thoracic endovascular aortic repair [TEVAR]) and medical groups. Serial computed tomography at 3 thoracic levels was performed using standardized protocols, with aortic growth assessed by smoothing and mixed-effects regression.
RESULTS: Patients with IMH were older than those with AD (70.6 ± 12.3 vs. 60.5 ± 16.1 years; P = 0.0002), with modest early TEVAR rates (28.8% vs. 24.1%). Among medically managed patients, delayed intervention occurred in 13.5% and 6.7% of patients with AD and IMH. Indications differed: progressive enlargement in AD and heterogeneous causes in IMH. Mean time to intervention was longer in patients with AD (18.5 months; 3.2 months excluding one outlier) than in those with IMH (3.0 months). TEVAR promoted favorable remodeling in both diseases but did not improve survival. IMH prevalence was higher than that in Western cohorts, aligning with Asian data. Changes in the aortic diameter were strongly linked to false lumen thickness in AD and hematoma thickness in IMH.
CONCLUSION: Despite similar guidelines, AD and IMH exhibit distinct remodeling patterns. Conservative therapy remains effective in selected uncomplicated cases, whereas TEVAR improves remodeling without a survival benefit. Progressive enlargement in uncomplicated AD suggests that performing TEVAR in early stages is beneficial.