| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
J Thorac Cardiovasc Surg 2002;123:1051-1059
© 2002 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease (ACD) |
From the Section of Cardiothoracic Surgerya and the Department of Diagnostic Imaging,b Yale University, New Haven, Conn, and the Department of Epidemiology,c Ohio State University, Columbus, Ohio.
Read at the Eighty-first Annual Meeting of The American Association for Thoracic Surgery, San Diego, Calif, May 6-9, 2001.
Received for publication May 14, 2001. Revisions requested June 26, 2001; revisions received Sept 10, 2001. Accepted for publication Oct 25, 2001. Address for reprints: John A. Elefteriades, MD, 333 Cedar St, 121 FMB, New Haven, CT 06510 (E-mail: john.elefteriades{at}yale.edu).
Objective: Most studies on variant forms of aortic dissection—penetrating ulcer and intramural hematoma—have focused on the initial presenting episode, with scant follow-up. This investigation provides midterm follow-up of penetrating ulcer and intramural hematoma to determine whether the aorta shows healing according to radiography, goes on to dilate, or tends to rupture during later follow-up.
Methods: Forty-five patients with penetrating ulcers (n = 26) or intramural hematomas (n = 19) were treated at our institution. Ten patients with penetrating ulcers were male and 16 were female, and their ages ranged from 54 to 87 years (mean 72 years). Eight patients with intramural hematomas were male and 11 were female, and their ages ranged from 54 to 88 years (mean 74 years). These patients all had symptoms of aortic disease. Patients with incidental imaging findings were not considered.
Results: In the group with penetrating ulcers, rupture occurred during the initial admission in 10 (38%) cases, 17 patients (65%) underwent surgery, and 22 patients (85%) survived to hospital discharge. Among those with intramural hematomas, rupture occurred during the initial admission in 5 cases (26%), 7 patients (37%) underwent surgery, and 16 patients (84%) survived to hospital discharge. Follow-up ranged from 1 month to 12.5 years (mean 3.4 years). No ischemic vascular complications occurred. Imaging follow-up was available for 26 of the 45 patients. Of these, 19% of lesions showed resolution, 23% had worsened, 39% had progressed to typical dissection, and 19% were unchanged. Six late deaths were known to be caused by rupture. In the group with penetrating ulcers, aortic diameter increased from 4.8 to 5.1 cm during the course of 14 months. In the group with intramural hematomas, aortic diameter increased from 5.3 to 5.9 cm during the course of 21 months. Overall survivals were 80% at 1 year, 73% at 3 years, and 66% at 5 years.
Conclusions: Intramural hematoma and penetrating ulcer are lesions associated with advanced age. Women predominate. Penetrating ulcer and intramural hematoma rupture both early and late. Radiographically documented worsening, improvement, or frank dissection may occur with time. Aortic growth does occur (0.2 cm per year for penetrating ulcer and 0.4 cm per year for intramural hematoma). Vascular ischemic complications do not occur. Because of the high early rupture rate, the frequency of radiographic worsening, and the documented occurrence of late rupture, we now recommend surgical replacement of the aorta for these virulent vascular lesions as long as the patient's comorbidities do not preclude surgical intervention.
This article has been cited by other articles:
|
|
 |
|
  W. Swee and M. D. Dake Endovascular Management of Thoracic Dissections Circulation, March 18, 2008; 117(11): 1460 - 1473. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Shimokawa, N. Ozawa, S. Takanashi, and T. Itoh Intermediate-Term Results of Surgical Treatment of Acute Intramural Hematoma Involving the Ascending Aorta Ann. Thorac. Surg., March 1, 2008; 85(3): 982 - 986. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Botta, K. Buttazzi, V. Russo, M. Parlapiano, V. Gostoli, R. Di Bartolomeo, and R. Fattori Endovascular Repair for Penetrating Atherosclerotic Ulcers of the Descending Thoracic Aorta: Early and Mid-Term Results Ann. Thorac. Surg., March 1, 2008; 85(3): 987 - 992. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. R. Brinster Invited Commentary Ann. Thorac. Surg., March 1, 2008; 85(3): 992 - 993. [Full Text] [PDF]
|
|
|
|
 |
|
 U. Sadat, A. Titchner, N. Noor, J. Naik, and J. R. Boyle Endovascular Repair of a Penetrating Thoracic Aortic Ulcer Presenting With Left Recurrent Laryngeal Nerve Palsy Vascular and Endovascular Surgery, January 1, 2008; 41(6): 556 - 558. [Abstract] [PDF]
|
|
|
|
|
|
L. G. Svensson, N. T. Kouchoukos, D. C. Miller, J. E. Bavaria, J. S. Coselli, M. A. Curi, H. Eggebrecht, J. A. Elefteriades, R. Erbel, T. G. Gleason, et al. Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts Ann. Thorac. Surg., January 1, 2008; 85(1_Supplement): S1 - S41. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. G. Gleason and L. C. Benjamin Conventional Open Repair of Descending Thoracic Aortic Aneurysms Perspectives in Vascular Surgery and Endovascular Therapy, June 1, 2007; 19(2): 110 - 121. [Abstract] [PDF]
|
|
|
|
|
|
P. F. Ford and M. A. Farber Role of Endovascular Therapies in the Management of Diverse Thoracic Aortic Pathology Perspectives in Vascular Surgery and Endovascular Therapy, June 1, 2007; 19(2): 134 - 143. [Abstract] [PDF]
|
|
|
|
 |
|
 B. Marcheix, P. Demers, F. V. Eynden, Y. Lamarche, E. Therasse, and R. Cartier Alternative approach for stent grafting of the thoracic descending aorta: The antegrade right axillary approach J. Thorac. Cardiovasc. Surg., June 1, 2007; 133(6): 1639 - 1641. [Full Text] [PDF]
|
|
|
|
|
|
T. M. Sundt Intramural Hematoma and Penetrating Atherosclerotic Ulcer of the Aorta Ann. Thorac. Surg., February 1, 2007; 83(2): S835 - S841. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. R. Brinster, G. H. Wheatley III, J. Williams, V. G. Ramaiah, E. B. Diethrich, and J. A. Rodriguez-Lopez Are Penetrating Aortic Ulcers Best Treated Using an Endovascular Approach? Ann. Thorac. Surg., November 1, 2006; 82(5): 1688 - 1691. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M R Jones and J H Reid Emergency chest radiology: thoracic aortic disease and pulmonary embolism Imaging, September 1, 2006; 18(3): 122 - 138. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Usui, H. Masumoto, T. Akita, M. Yoshikawa, H. Murayama, and Y. Ueda Multiple Penetrating Aortic Ulcers Ann. Thorac. Surg., February 1, 2006; 81(2): 750 - 750. [Full Text] [PDF]
|
|
|
|
|
|
K. Uchida, K. Imoto, M. Takahashi, S.-i. Suzuki, S. Isoda, M. Sugiyama, J. Kondo, and Y. Takanashi Pathologic Characteristics and Surgical Indications of Superacute Type A Intramural Hematoma Ann. Thorac. Surg., May 1, 2005; 79(5): 1518 - 1521. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Evangelista, D. Mukherjee, R. H. Mehta, P. T. O'Gara, R. Fattori, J. V. Cooper, D. E. Smith, J. K. Oh, S. Hutchison, U. Sechtem, et al. Acute Intramural Hematoma of the Aorta: A Mystery in Evolution Circulation, March 1, 2005; 111(8): 1063 - 1070. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Savini, F. Casselman, M. U. Ergenoglu, I. Degrieck, F. Van Praet, R. De Geest, F. Wellens, H. Jeanmart, and H. Vanermen Surgical management of progression to type A dissection from an intramural hematoma previously treated with endovascular stent graft placement J. Thorac. Cardiovasc. Surg., November 1, 2004; 128(5): 773 - 775. [Full Text] [PDF]
|
|
|
|
|
|
S. Kimura, M. Noda, M. Usui, and M. Isobe Diagnostic criteria for penetrating atheromatous ulcer of the thoracic aorta Ann. Thorac. Surg., September 1, 2004; 78(3): 1070 - 1072. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. R. Cho, A. W. Stanson, D. D. Potter, K. J. Cherry, H. V. Schaff, and T. M. Sundt III Penetrating atherosclerotic ulcer of the descending thoracic aorta and arch J. Thorac. Cardiovasc. Surg., May 1, 2004; 127(5): 1393 - 1401. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Moizumi, T. Komatsu, N. Motoyoshi, and K. Tabayashi Clinical features and long-term outcome of type A and type B intramural hematoma of the aorta J. Thorac. Cardiovasc. Surg., February 1, 2004; 127(2): 421 - 427. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Demers, D. C. Miller, R. S. Mitchell, S. T. Kee, L. Chagonjian, and M. D. Dake Stent-graft repair of penetrating atherosclerotic ulcers in the descending thoracic aorta: mid-term results Ann. Thorac. Surg., January 1, 2004; 77(1): 81 - 86. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Kaji, T. Akasaka, M. Katayama, A. Yamamuro, K. Yamabe, K. Tamita, M. Akiyama, N. Watanabe, K. Tanemoto, S. Morioka, et al. Long-Term Prognosis of Patients With Type B Aortic Intramural Hematoma Circulation, September 9, 2003; 108(90101): II-307 - 311. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
