Table of contents
Aortic intramural hematoma
What's new
Updated 2024 EACTS/STS guidelines for the management of aortic intramural hematoma.
Background
Overview
Definition
Aortic IMH is a condition characterized by bleeding within the wall of the aorta without an entrance tear.
1
Pathophysiology
The pathophysiology of aortic IMH involves two main mechanisms: extension of aortic dissection and primary intimal tear with hematoma propagation.
2
Epidemiology
The incidence of aortic IMH is estimated at 1.2 per 100,000 person-years.
3
Disease course
Clinically, patients with aortic IMH often present with sudden, severe, and persistent chest or back pain. Complications include progression to aortic dissection or rupture.
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Prognosis and risk of recurrence
The prognosis of aortic IMH can vary based on factors such as the extent and location of the hematoma. It usually carries a lower mortality rate than aortic dissection.
5
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of aortic intramural hematoma are prepared by our editorial team based on guidelines from the Society of Thoracic Surgeons (STS/EACTS 2024), the American Heart Association (AHA/ACC 2022), the American Association for Thoracic Surgery (AATS 2021), the European Society of Cardiology (ESC 2014), and the Society for Cardiovascular Angiography and Interventions (SCAI/STS/SVM/AATS/SCA/AHA/ACR/ACC/ASA/SIR...
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Classification and risk stratification
Diagnostic investigations
Medical management
Nonpharmacologic interventions
Surgical interventions
Indications for surgery
As per EACTS/STS 2024 guidelines:
Perform emergency surgery in patients with acute type A aortic IMH with complications or high-risk features.
B
Perform urgent aortic repair in patients with acute complicated type B aortic IMH.
B
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