J Vasc Surg. 2021 Dec 29:S0741-5214(21)02735-X. doi: 10.1016/j.jvs.2021.12.055. Online ahead of print.
ABSTRACT
OBJECTIVES: To provide the midterm results of endovascular repair for acute zone 0 intramural hematoma patients with the most proximal tear or ulcer-like projection in the descending aorta.
METHODS: Information about acute zone 0 intramural hematoma patients with the most proximal tear or ulcer-like projection in the descending aorta from January 1, 2010, to December 31, 2019, were retrospectively reviewed. We performed Kaplan-Meier curves to calculate the intervention-free survival and survival after endovascular or open repair. We used propensity score matching to compare the outcomes of endovascular with surgical repair.
RESULTS: This study included 99 patients, 34 of them initially underwent medical treatment; the 0.5, 1, 3 years intervention-free survival rates were 23.5%, 17.6%, and 14.7%, respectively. 51 patients underwent endovascular therapy; most of them had a maximal diameter of ascending aorta＜50mm and maximal diameter of intramural hematoma in ascending aorta＜10mm, the 1, 3, 5 years survival rate were all 98.0%. 42 patients underwent open surgery, and the 1, 3, 5 years survival rates were all 92.9%. After propensity score matching, there was no statistical difference in 30 days and follow-up mortality, while the endovascular repair was associated with shorter operation time (69 vs. 314 minutes, p＜.001), shorter length of ICU stay (24 vs. 70 hours, p=.001), and shorter length of hospital stay (7 vs. 12 days, p=.011).
CONCLUSION: In acute zone 0 intramural hematoma patients with the most proximal tear or ulcer-like projection in the descending aorta, besides open surgery, endovascular repair is optional on the premise of the maximal diameter of ascending aorta＜50mm and maximal diameter of intramural hematoma in ascending aorta＜10mm.
PMID:34973400 | DOI:10.1016/j.jvs.2021.12.055
