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] .