Date: 18 Nov 2012
Aortic Branch Artery Pseudoaneurysms Associated with Intramural Hematoma: When and How to Do Endovascular Embolization
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To describe when and how to perform endovascular embolization of aortic branch artery pseudoaneurysms associated with type A and type B intramural hematoma (IMH) involving the descending thoracic and abdominal aorta (DeBakey I and III) that increased significantly in size during follow-up.
Materials and Methods
Sixty-one patients (39 men; mean ± standard deviation age 66.1 ± 11.2 years) with acute IMH undergoing at least two multidetector computed tomographic examinations during follow-up for 12 months or longer were enrolled. Overall, 48 patients (31 men, age 65.9 ± 11.5) had type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III).
Among the 48 patients, 26 (54 %; 17 men, aged 64.3 ± 11.4 years) had 71 aortic branch artery pseudoaneurysms. Overall, during a mean follow-up of 22.1 ± 9.5 months (range 12–42 months), 31 (44 %) pseudoaneurysms disappeared; 22 (31 %) decreased in size; two (3 %) remained stable; and 16 (22 %) increased in size. Among the 16 pseudoaneurysms with increasing size, five of these (three intercostal arteries, one combined intercostobronchial/intercostal arteries, one renal artery), present in five symptomatic patients, had a significant increase in size (thickness >10 mm; width and length >20 mm). These five patients underwent endovascular embolization with coils and/or Amplatzer Vascular Plug. In all patients, complete thrombosis and exclusion of aortic pseudoaneurysm and relief of back pain were achieved.
Aortic branch artery pseudoaneurysms associated with type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III) may be considered relatively benign lesions. However, a small number may grow in size or extend longitudinally with clinical symptoms during follow-up, and in these cases, endovascular embolization can be an effective and safe procedure.
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- Aortic Branch Artery Pseudoaneurysms Associated with Intramural Hematoma: When and How to Do Endovascular Embolization
CardioVascular and Interventional Radiology
Volume 36, Issue 2 , pp 422-432
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- Thoracic aorta
- Intramural hematoma
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- Author Affiliations
- 1. Department of Radiology and Interventional Radiology, IRCCS San Martino University Hospital, IST, National Institute for Cancer Research, Largo Rosanna Benzi 10, 16132, Genova, Italy
- 2. Department of Cardiac Surgery, IRCCS San Martino University Hospital, IST, National Institute for Cancer Research, Largo Rosanna Benzi 10, 16132, Genova, Italy
- 3. Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-0326, USA