Acute aortic intramural hematoma: an analysis from the International Registry of Acute Aortic Dissection.


Journal Article

BACKGROUND: Acute aortic intramural hematoma (IMH) is an important subgroup of aortic dissection, and controversy surrounds appropriate management. METHODS AND RESULTS: Patients with acute aortic syndromes in the International Registry of Acute Aortic Dissection (1996-2011) were evaluated to examine differences between patients (based on the initial imaging test) with IMH or classic dissection (AD). Of 2830 patients, 178 had IMH (64 type A [42%], 90 type B [58%], and 24 arch). Patients with IMH were older and presented with similar symptoms, such as severe pain. Patients with type A IMH were less likely to present with aortic regurgitation or pulse deficits and were more likely to have periaortic hematoma and pericardial effusion. Although type A IMH and AD were managed medically infrequently, type B IMH were more frequently treated medically. Overall in-hospital mortality was not statistically different for type A IMH compared to AD (26.6% versus 26.5%; P=0.998); type A IMH managed medically had significant mortality (40.0%), although less than classic AD (61.8%; P=0.195). Patients with type B IMH had a hospital mortality that was less but did not differ significantly (4.4% versus 11.1%; P=0.062) from classic AD. One-year mortality was not significantly different between AD and IMH. CONCLUSIONS: Acute IMH has similar presentation to classic AD but is more frequently complicated with pericardial effusions and periaortic hematoma. Patients with IMH have a mortality that does not differ statistically from those with classic AD. A small subgroup of type A IMH patients are managed medically and have a significant in-hospital mortality.

Full Text

Duke Authors

Cited Authors

  • Harris, KM; Braverman, AC; Eagle, KA; Woznicki, EM; Pyeritz, RE; Myrmel, T; Peterson, MD; Voehringer, M; Fattori, R; Januzzi, JL; Gilon, D; Montgomery, DG; Nienaber, CA; Trimarchi, S; Isselbacher, EM; Evangelista, A

Published Date

  • September 11, 2012

Published In

Volume / Issue

  • 126 / 11 Suppl 1

Start / End Page

  • S91 - S96

PubMed ID

  • 22965999

Pubmed Central ID

  • 22965999

Electronic International Standard Serial Number (EISSN)

  • 1524-4539

Digital Object Identifier (DOI)

  • 10.1161/CIRCULATIONAHA.111.084541


  • eng

Conference Location

  • United States