Endovascular repair for acute zone 0 intramural hematoma with most proximal tear or ulcer-like projection in the descending aorta

Objectives

To provide the midterm results of endovascular repair for acute zone 0 intramural hematoma patients with the most proximal tear or ulcer-like projection in the descending aorta.

Methods

Information about acute zone 0 intramural hematoma patients with the most proximal tear or ulcer-like projection in the descending aorta from January 1, 2010, to December 31, 2019, were retrospectively reviewed. We performed Kaplan-Meier curves to calculate the intervention-free survival and survival after endovascular or open repair. We used propensity score matching to compare the outcomes of endovascular with surgical repair.

Results

This study included 99 patients, 34 of them initially underwent medical treatment; the 0.5, 1, 3 years intervention-free survival rates were 23.5%, 17.6%, and 14.7%, respectively. 51 patients underwent endovascular therapy; most of them had a maximal diameter of ascending aorta＜50mm and maximal diameter of intramural hematoma in ascending aorta＜10mm, the 1, 3, 5 years survival rate were all 98.0%. 42 patients underwent open surgery, and the 1, 3, 5 years survival rates were all 92.9%. After propensity score matching, there was no statistical difference in 30 days and follow-up mortality, while the endovascular repair was associated with shorter operation time (69 vs. 314 minutes, p＜.001), shorter length of ICU stay (24 vs. 70 hours, p=.001), and shorter length of hospital stay (7 vs. 12 days, p=.011).

Conclusion

In acute zone 0 intramural hematoma patients with the most proximal tear or ulcer-like projection in the descending aorta, besides open surgery, endovascular repair is optional on the premise of the maximal diameter of ascending aorta＜50mm and maximal diameter of intramural hematoma in ascending aorta＜10mm.