Meta-analysis of 143 reported cases of aortic intramural hematoma

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Abstract

Aortic intramural hematoma (IMH) is a clinical condition that has still not been completely defined. We conducted a meta-analysis of reported cases and analyzed the demographic profiles, imaging modalities, pathologic sites, and treatment strategies in relation to outcome in 143 patients with IMH. We performed an English language search of Medline for manuscripts with the keywords “aortic diseases,” “aorta AND hematoma,” and “intramural hematoma.” Data from 143 reported cases were extracted. IMH of the aorta has a reported incidence of 5% to 20% among patients with acute aortic syndromes and a mortality rate of 21%. Most patients were men (61%) and median age was 68 years (range 15 to 88). Hypertension was a predisposing factor in 53% of the patients. Most patients had chest and/or back pain (80%). Transesophageal echocardiography, computer tomographic scan, or magnetic resonance imaging may be effectively used to diagnose this condition. There is no difference in the overall mortality rates in Stanford type A versus type B patients. Patients with Stanford type A IMH who underwent surgery, compared with those who underwent medical management, had a significantly better prognosis (14% vs 36% mortality, respectively, p <0.02). Patients in Stanford group A who received medical treatment had a higher mortality rate than those in group B who received medical treatment (36% vs 14% mortality respectively, p <0.02). In type B patients, medical and surgical outcomes were similar.

Section snippets

Data sources

We performed an English language search of Medline from 1986 to November 1998 for studies with the keywords “aortic diseases,” “aorta AND hematoma,” and “intramural hematoma.” We also reviewed references from select case reports. Studies that did not provide sufficient individual patient data were excluded. We extracted data from 19 studies that contained 143 cases.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19

Data collection

Three reviewers (RM, PR, and PM) collected data using a

Results

In autopsy studies, IMH accounts for 5% to 13% of all patients with acute aortic syndromes20, 21, 22(Figure 1). Several prospective studies7, 19, 23 have documented IMH in 13% of patients admitted to hospital with clinical signs of aortic dissection. Other investigators have documented a slightly higher incidence. Vilacosta et al1 reported a 17% incidence of nontraumatic IMH in their study and Keren et al24 diagnosed IMH in 20% of patients with acute aortic syndromes.

A total of 143 cases of

Clinical presentation

Most of the patients in this analysis were men (61%). Fifty-three percent of the patients had hypertension. Most of the patients had chest and/or back pain (80%). A small percentage of patients (0.7%) were asymptomatic and the condition was only diagnosed at routine screening. Furthermore, 2% of patients had syncope in the absence of chest pain. Of the 8 patients who had traumatic IMHs, 6 cases were due to motor vehicle accidents and the remainder were due to intra-aortic balloon pumps

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    This study was supported in part by the Women’s League for Medical Research, Albert Einstein Medical Center, Philadelphia, Pennsylvania.

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