Introduction
Although the current treatment strategy (wait-and-watch strategy) for
type B intramural hematoma (IMHB) is in line with the management of type
B dissections, the long-term outcomes of IMHBs are not as good as those
of type B dissections [1-4] . Schoenhoff et al.[5] reported that 43% of IMHB patients underwent thoracic
endovascular aortic repair (TEVAR) during the first two weeks because of
the visualization of an entry tear and development of an aneurysm, and
19% of patients received TEVAR after the acute phase and during the
first-year. Durham and colleagues also reported that the
survival rates of type B intramural hematoma patients who underwent
interventional treatment was only 76% and only 40% of patients did not
require reintervention [6] . The cause of this phenomenon is
that the evolution of IMHBs is highly unpredictable and can vary from
complete resolution to abrupt rupture.
The prevalence of diabetes mellitus (DM) in patients requiring cardiac
surgery is significantly increasing and achieving tight perioperative
glycemic control in DM patients could decrease perioperative morbidity
and improve survival [7] . Regarding aortic diseases,
current studies have demonstrated a negative correlation between DM and
the occurrence of aortic diseases [8-11] . However, previous
studies are contradictory in that patients with DM were found to have
poorer outcomes after abdominal aortic aneurysm repair[12], whereas mortality and clinical complications in type
B aortic dissection patients after TEVAR were significantly reduced in
DM patients [13] . In our previous study, we had
demonstrated that uncomplicated type A IMH patients with DM (receiving
the “wait‐and‐watch strategy” and tight glycemic control) may have
lower aorta‐related mortality and rates of aorta‐related adverse events
and reinterventions than the non-DM group [14] And whether
patients with uncomplicated IMHB (receiving the “wait‐and‐watch
strategy”) may benefit from the tight glycemic control remains unclear.
In sum, we hypothesized that in uncomplicated IMHB patients who received
the “wait-and-watch strategy” (combined with tight glucose
management), patients with DM (compared with patients without DM) would
benefit from such a treatment strategy. In this study, we aimed to
summarize the clinical presentation, therapeutic approaches, and
outcomes of IMHB patients with and without DM.