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Carlo Savini
Filip Casselman
Ivan Degrieck
Raphael De Geest
Francis Wellens
Hugues Jeanmart
Hugo Vanermen
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J Thorac Cardiovasc Surg 2004;128:773-775
© 2004 The American Association for Thoracic Surgery

Brief communication

Surgical management of progression to type A dissection from an intramural hematoma previously treated with endovascular stent graft placement

Carlo Savini, MD*, Filip Casselman, MD, PhD*, Mehmet U. Ergenoglu, MD, Ivan Degrieck, MD, Franck Van Praet, MD, Raphael De Geest, MD, Francis Wellens, MD, Hugues Jeanmart, MD, Hugo Vanermen, MD

Department of Cardiovascular and Thoracic Surgery, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium

Received for publication April 28, 2004; revisions received May 13, 2004; accepted for publication May 21, 2004.

* Address for reprints: Filip Casselman, MD, PhD, Department of Cardiovascular and Thoracic Surgery, O.L.V. Clinic, Moorselbaan 164, 9300 Aalst, Belgium (E-mail: fillip.casselman@olvz-aalst.be).

The first 20% of the full text of this article appears below.

The best management of intramural hematoma of the aorta (IMH) is still controversial. There is increasing evidence in the literature1,2 to justify the same approach as that used in classic aortic dissection.

We report a case of a patient in whom an IMH, which involved the ascending aorta, the arch, and the descending thoracic aorta, initially progressed to type B and, 1 month later, to type A aortic dissection.

Clinical summary

A 58-year-old man with a history of hypertension was admitted for posterior chest pain. Chest computed tomographic (CT) scanning (Figure 1, A.. revealed an IMH in the ascending aorta, the arch, and the proximal descending aorta. Because the patient was hemodynamically stable, conservative antihypertensive treatment was instituted. Several days later, persistent pain urged a new CT scan, which showed a tear-like lesion in the proximal descending thoracic aorta (Figure 1, B.. for which an endovascular stent graft (Talent 34 mm, Medtronic AVE) was inserted (by ID). The immediate result was satisfactory, and the patient was discharged a few days later. Four weeks after the . . . [Full Text of this Article]






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