Clinical Treatment Strategy And Efficacy Analysis Of Type Stanford B Aortic Wall Hematoma

Objective: To review and summarize the clinical treatment methods of Stanford type B aortic intramural hematoma and their differences in efficacy.Methods: Clinical and follow-up data of patients admitted to the Yijishan Hospital of the First Affiliated Hospital of Wannan Medical College from January 2017 to June 2022.The patients were divided into drug therapy group and transthoracic endovascular aortic repair(TEVAR)group according to the final treatment methods,and the TEVAR group was divided into acute endovascular repair group(onset time ≤ 14 days)and subacute endovascular repair group(onset time > 14 days)according to the different treatment timing.The clinical data of the patients in the above groups and the follow-up results up to February 2023 were compared,and the analysis of variance and χ2 test were used for statistical analysis.Results: In the medical treatment group,there were 17 patients,including10 patients with the maximum thickness of CTA hematoma ≥ 10 mm or the maximum diameter of aorta ≥ 40 mm,1 patient died of aortic rupture during medical treatment in the hospital,and 1 patient died during follow-up half a year after discharge.One patient developed complications of Stanford type a aortic dissection during drug treatment in the hospital and died after refusing further treatment.Three patients developed complications of Stanford type B aortic dissection during follow-up.The remaining patients were reexamined with aortic CTA during follow-up,which showed that the hematoma was reduced or absorbed;In 7 patients with the maximum thickness of hematoma < 10 mm and the maximum diameter of aorta < 40 mm,the hematoma was reduced or disappeared during the follow-up.There were 81 cases in the endovascular repair group and 47 cases in the acute endovascular repair group.There were 32 patients with the maximum thickness of hematoma ≥ 10 mm or the maximum diameter of aorta ≥ 40 mm in CTA.One patient died of cerebral infarction after operation.Type I endoleak complications were found in 7 patients by CTA reexamination,and one of them was readmitted for intervention because of type I endoleak complications and distal abdominal aortic aneurysm dilatation during follow-up.No patient died during follow-up and hematoma was reduced or absorbed by CTA reexamination in other patients;There were 15 patients with the maximum thickness of hematoma less than 10 mm and the maximum diameter of aorta less than 40 mm in CTA.There were no deaths and complications in the hospital and postoperative follow-up,and the hematoma decreased or disappeared during the follow-up.In subacute endovascular repair group(n = 34),there were 26 patients with the maximum thickness of hematoma ≥ 10 mm or the maximum diameter of aorta ≥ 40 mm.There were no deaths and complications during hospitalization and postoperative follow-up,and the hematoma was reduced or absorbed during follow-up;In 8 patients with the maximum thickness of hematoma < 10 mm and the maximum diameter of aorta < 40 mm,no endoleak occurred postoperatively,and the hematoma decreased or disappeared during the follow-up.Conclusion: 1.Type Stanford B IMH initially has a maximum aortic diameter of 40 mm,with a high rate of serious complication events and all-cause mortality,and TEVAR treatment is recommended in such patients.2.Type Stanford B IMH,with 40 mm maximum aortic diameter or 10 mm maximum hematoma thickness,reduces the rate of stent-related complications(e.g.type I endoleak).