내과적 치료를 받은 대동맥 박리와 대동맥 벽내 혈종 환자들의 자연경과에 관한 다기관 경시적 추적관찰 연구

Abstract

Although the same treatment strategy has been applied for patients with aortic intramural hematoma (AIH) as typical aortic dissection (AD), the natural history of AIH with medical treatment is not known clearly. The purposes of this study were to test the hypothesis that absence of direct flow communication through intimal tear in AIH has different impact on clinical course compared with typical AD and to clarify the natural history of AIH. Methods：Total 181 patients of acute aortic pathology (AD/AIH＝57/124) were enrolled from 5 institutions. Patients received medical treatment without surgical intervention regardless of the affected site in acute stage, and follow-up imaging studies (FUIS) were performed in 105 patients with AIH. Clinical data of these patients were retrospectively analyzed. Results：Fifty-four patients showed involvement of the ascending aorta (AD/AIH＝13/41) and 127 revealed distal pathology (AD/AIH＝44/83). Compared to the patients with AD, those with AIH were older regardless of the type and showed higher incidence of pleural effusion and mediastinal hemorrhage. In-hospital mortality of proximal AIH was 7%, which was significantly lower than that of proximal AD (62%)；mortality of distal AIH was also lower than that of distal AD (1.2 Vs 9%, p