Treatment Strategy for Intramural Hematoma
Patients with uncomplicated IMHBs received medical therapy to control
their pain (intravenous opiate analgesia), heart rate (less than 80
beats per minute), and blood pressure (systolic blood pressure between
100 and 120 mmHg) [1] .
The acute phase was defined as the
first fourteen days from the onset of IMHB, and the disease was
considered stable after fourteen uneventful days (patients were
discharged) [1] . Electrocardiographic-triggered CTA (GE
Healthcare, Milwaukee, WI) was performed at least twice during the acute
phase (once upon admission and once before discharge) in patients
without disease progression and in those with well-controlled blood
pressure, heart rate and pain; in eventful cases (uncontrollable back
pain combined with hemodynamic instability), CTA examinations were
adjusted accordingly [1] . The patients were followed
clinically according to standard surveillance protocols [1]
[15-17] . During the follow-up, CTA was also performed at 1, 3, 6,
and 12 months and then annually during the extended follow-up. Disease
progression was defined as increased pleural effusion, hematoma
thickening (thickness ≥10 mm), development of an aortic pseudoaneurysm,
aortic dissection or signs of aortic rupture. Under the following
situations, patients would receive TEVAR or surgery treatment: during
the acute phase, expansion of IMH and development of pseudoaneurysms
despite medical therapy, development of ulcer-like projections (ULP),
and signs of aortic rupture (uncontrollable back pain combined with a
precipitous decrease in blood pressure); and during the chronic phase,
development of aortic dissection, rapid growth of ULPs or aorta
diameters (>5 mm/year), maximum aorta diameters
> 55 mm, and signs of aortic rupture [1] .