Survival and Aortic Remodeling Outcomes in Patients with Type B Aortic Intramural Hematoma in Endovascular Era: An Observational Cohort Study

Abstract

Background

The late outcomes of patients with type B aortic intramural hematoma (IMH) receiving medical treatment (MT) have varied greatly. Whether endovascular stent graft placement in the descending aorta will provide beneficial effects for patients with type B IMH has remained uncertain. We have presented the survival and aortic remodeling outcomes for patients with type B IMH stratified by the treatment received (MT vs endovascular treatment [ET]).

Methods

The participants were consecutively recruited from September 2010 to August 2017 from an institutional registry for type B IMH at Fuwai Hospital. The cohort was divided into two subgroups according to their treatment (MT vs ET). Kaplan-Meier estimations and propensity score-matched analysis were used to evaluate the outcomes after MT and ET.

Results

The cohort included 347 patients with type B IMH (189 in the MT subgroup and 158 in the ET subgroup). During hospitalization, two patients (1.1%) in the MT subgroup and one patient (0.6%) in the ET subgroup had died. During follow-up (median, 3.4 years; interquartile range, 2.3-4.5 years; total patient-years, 1191.1), 36 patients had died of all causes. The cumulative probability of death was 0.03 per patient-year. The Kaplan-Meier estimated survival rates at 5 years were higher for the ET subgroup (94.9%) than for the MT subgroup (84.2%; P = .001). Cox regression analysis showed that ET was associated with a lower risk of death (hazard ratio, 0.32; 95% confidence interval, 0.15-0.69; P = .004). Follow-up computed tomography scans were completed for 244 patients. The incidence of IMH resolution in the ET subgroup (53.5%) was higher than that in the MT subgroup (33.3%; P = .003).

Conclusions

The present findings revealed different survival and aortic remodeling outcomes according to MT vs ET for consecutive patients with type B IMH. The survival rate was improved for the patients in the ET subgroup compared with that for the MT subgroup. Also, late progression to aortic dissection was less frequent in the ET subgroup.