Background: Intramural hematoma (IMH) of the aorta is a well-known variant of aortic dissection; however, the optimal initial treatment strategy for type A IMH remains controversial. The purpose of this study was to compare clinical outcome of IMH with those of aortic dissection (AD) involving ascending aorta. Methods: From January 1997 to Jun 2008, 50 IMH and 77 AD were diagnosed in 128 consecutive patients, 56 of these were acute aortic syndrome involving ascending aorta. Direct comparison of the clinical data of 40 patients with proximal AD (16 men, 64 ± 12 years) and 16 patients with IMH (6 men, 69 ± 10 years) was performed retrospectively. Results: All 56 patients were followed for an average of 29 months (maximum 9.3 years). The development of mediastinal hemorrhage and pericardial and pleural effusion was more frequent in patients with IMH. Although medical treatment was more frequently selected in the IMH group (81% vs. 43%, p = 0.009), the mortality rate with medical treatment was lower in patients with IMH than it was in patients with AD (19% vs. 50%, p = 0.039). The long-term survival rates were 81% in patients with IMH and 44% in patients with AD (p = 0.036) (Figure). No independent predictor of IMH-related events was found on multivariate analysis. Conclusion: Patients with proximal IMH shows better prognosis with medical treatment compared to those with AD. In selected cases, medical management in patients with proximal IMH may be reasonable.
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