Comparative Outcomes of Thoracic Endovascular Aortic Repair (TEVAR) and Surgical Management for Type A and Type B Intramural Hematomas: A Single-Center Retrospective Cohort Study

Dang Nguyen; Yusuf Qureshi; Chibuikem Iheagwaram; Amira Mohamed Taha; Michael Diaz; Ryan Ahmed; Pari Patel; Shahriar Siam Huda; Authoy Das; Triet Nguyen M.; Phat K. Huynh; Miyaz Ansari; Ryan Shargo; Ngoc Phuong Hong Tao; Loc Vu; Heath Rutledge-Jukes; Gia Han Lam; Le Nhat Thao; Phan Thuan; Ngoc-Minh Vuong; Tran Van-Phu; Chuong Pham; Nityanand Jain; Dinh Nguyen

doi:10.1016/s0735-1097(24)02924-3

Abstract

Background
Type A acute aortic intramural hematomas (IMHs), especially with thrombi in the ascending aorta, pose an increased risk of complications relative to Type B. The therapeutic direction for Type A IMH remains contentious. This study contrasts the outcomes of TEVAR and open surgical approaches in managing IMHs.

Methods
We conducted a single-center, retrospective analysis involving patients diagnosed with either Type A, retrograde A, or Type B IMH who underwent either surgical or endovascular treatments from January 2017 to December 2020. Parameters such as three-year survival, overall mortality, vascular and hemorrhagic events, renal damage, cardiac anomalies, neurological events, and need for re-intervention or readmission were scrutinized.

Results
Our cohort included 31 patients with IMH who received post-intervention follow-up. The subgroups were categorized into: 11 after Type A surgical treatment (average age: 63 ± 9 years; 55% male), 7 after Type A endovascular treatment (average age: 67 ± 6 years; 57% male), and 13 after Type B endovascular treatment (average age: 64 ± 8 years; 77% male). Notably, the median hospital stay durations for IMH-A, retrograde IMH-A, and IMH-B were 13, 5, and 4 days, respectively. Postoperative complications were markedly prevalent in IMH-A (n=8, 73%) relative to the retrograde IMH-A and IMH-B categories. One and three-year survival rates post-repair were discerned to be 82%/68%, 100%/100%, and 100%/75% for Type A surgical, Type A endovascular, and Type B endovascular approaches, respectively.

Conclusions
Aortic IMHs are notably linked to aortic dissections, leading to life-threatening outcomes. Despite the traditional preference for surgical remedies in most IMH instances, our data suggests that TEVAR offers a promising, minimally invasive alternative, especially for Type A retrograde and Type B IMHs.

Original language	English
Pages (from-to)	934-934
Journal	Journal of the American College of Cardiology (JACC)
Volume	83
Issue number	13, Suppl.A
DOIs	https://doi.org/10.1016/s0735-1097(24)02924-3
Publication status	Published - 6 Apr 2024
Externally published	Yes
Event	American College of Cardiology’s 73rd Scientific Session and Expo - Atlanta, United States Duration: 6 Apr 2024 → 8 Apr 2024 Conference number: 73 https://www.expo.acc.org/ACC24/Public/enter.aspx

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords*

TEVAR
intramural hematoma
mortality
Survival analysis
endovascular interventions

Field of Science*

1.6 Biological sciences
2.1 Civil engineering
3.2 Clinical medicine
3.1 Basic medicine
3.3 Health sciences
2.8 Environmental biotechnology

Publication Type*

3.4. Other publications in conference proceedings (including local)

Access to Document

10.1016/s0735-1097(24)02924-3

https://www.jacc.org/doi/full/10.1016/S0735-1097%2824%2902924-3Licence: Unspecified
https://linkinghub.elsevier.com/retrieve/pii/S0735109724029243Licence: Unspecified

Cite this

Nguyen, D., Qureshi, Y., Iheagwaram, C., Taha, A. M., Diaz, M., Ahmed, R., Patel, P., Huda, S. S., Das, A., M., T. N., Huynh, P. K., Ansari, M., Shargo, R., Tao, N. P. H., Vu, L., Rutledge-Jukes, H., Lam, G. H., Thao, L. N., Thuan, P., ... Nguyen, D. (2024). Comparative Outcomes of Thoracic Endovascular Aortic Repair (TEVAR) and Surgical Management for Type A and Type B Intramural Hematomas: A Single-Center Retrospective Cohort Study. Journal of the American College of Cardiology (JACC), 83(13, Suppl.A), 934-934. https://doi.org/10.1016/s0735-1097(24)02924-3

@article{8eb118bf805e4e2289a88f94eb2e3372,

title = "Comparative Outcomes of Thoracic Endovascular Aortic Repair (TEVAR) and Surgical Management for Type A and Type B Intramural Hematomas: A Single-Center Retrospective Cohort Study",

abstract = "Background Type A acute aortic intramural hematomas (IMHs), especially with thrombi in the ascending aorta, pose an increased risk of complications relative to Type B. The therapeutic direction for Type A IMH remains contentious. This study contrasts the outcomes of TEVAR and open surgical approaches in managing IMHs. Methods We conducted a single-center, retrospective analysis involving patients diagnosed with either Type A, retrograde A, or Type B IMH who underwent either surgical or endovascular treatments from January 2017 to December 2020. Parameters such as three-year survival, overall mortality, vascular and hemorrhagic events, renal damage, cardiac anomalies, neurological events, and need for re-intervention or readmission were scrutinized. Results Our cohort included 31 patients with IMH who received post-intervention follow-up. The subgroups were categorized into: 11 after Type A surgical treatment (average age: 63 ± 9 years; 55\% male), 7 after Type A endovascular treatment (average age: 67 ± 6 years; 57\% male), and 13 after Type B endovascular treatment (average age: 64 ± 8 years; 77\% male). Notably, the median hospital stay durations for IMH-A, retrograde IMH-A, and IMH-B were 13, 5, and 4 days, respectively. Postoperative complications were markedly prevalent in IMH-A (n=8, 73\%) relative to the retrograde IMH-A and IMH-B categories. One and three-year survival rates post-repair were discerned to be 82\%/68\%, 100\%/100\%, and 100\%/75\% for Type A surgical, Type A endovascular, and Type B endovascular approaches, respectively. Conclusions Aortic IMHs are notably linked to aortic dissections, leading to life-threatening outcomes. Despite the traditional preference for surgical remedies in most IMH instances, our data suggests that TEVAR offers a promising, minimally invasive alternative, especially for Type A retrograde and Type B IMHs.",

keywords = "TEVAR, intramural hematoma, mortality, Survival analysis, endovascular interventions",

author = "Dang Nguyen and Yusuf Qureshi and Chibuikem Iheagwaram and Taha, \{Amira Mohamed\} and Michael Diaz and Ryan Ahmed and Pari Patel and Huda, \{Shahriar Siam\} and Authoy Das and M., \{Triet Nguyen\} and Huynh, \{Phat K.\} and Miyaz Ansari and Ryan Shargo and Tao, \{Ngoc Phuong Hong\} and Loc Vu and Heath Rutledge-Jukes and Lam, \{Gia Han\} and Thao, \{Le Nhat\} and Phan Thuan and Ngoc-Minh Vuong and Tran Van-Phu and Chuong Pham and Nityanand Jain and Dinh Nguyen",

year = "2024",

month = apr,

day = "6",

doi = "10.1016/s0735-1097(24)02924-3",

language = "English",

volume = "83",

pages = "934--934",

journal = "Journal of the American College of Cardiology (JACC)",

issn = "0735-1097",

publisher = "Elsevier Inc.",

number = "13, Suppl.A",

note = "American College of Cardiology{\textquoteright}s 73rd Scientific Session and Expo ; Conference date: 06-04-2024 Through 08-04-2024",

url = "https://www.expo.acc.org/ACC24/Public/enter.aspx",

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Nguyen, D, Qureshi, Y, Iheagwaram, C, Taha, AM, Diaz, M, Ahmed, R, Patel, P, Huda, SS, Das, A, M., TN, Huynh, PK, Ansari, M, Shargo, R, Tao, NPH, Vu, L, Rutledge-Jukes, H, Lam, GH, Thao, LN, Thuan, P, Vuong, N-M, Van-Phu, T, Pham, C, Jain, N & Nguyen, D 2024, 'Comparative Outcomes of Thoracic Endovascular Aortic Repair (TEVAR) and Surgical Management for Type A and Type B Intramural Hematomas: A Single-Center Retrospective Cohort Study', Journal of the American College of Cardiology (JACC), vol. 83, no. 13, Suppl.A, pp. 934-934. https://doi.org/10.1016/s0735-1097(24)02924-3

Comparative Outcomes of Thoracic Endovascular Aortic Repair (TEVAR) and Surgical Management for Type A and Type B Intramural Hematomas: A Single-Center Retrospective Cohort Study. / Nguyen, Dang; Qureshi, Yusuf; Iheagwaram, Chibuikem et al.
In: Journal of the American College of Cardiology (JACC), Vol. 83, No. 13, Suppl.A, 06.04.2024, p. 934-934.

Research output: Contribution to journal › Meeting Abstract › peer-review

TY - JOUR

T1 - Comparative Outcomes of Thoracic Endovascular Aortic Repair (TEVAR) and Surgical Management for Type A and Type B Intramural Hematomas

T2 - American College of Cardiology’s 73rd Scientific Session and Expo

AU - Nguyen, Dang

AU - Qureshi, Yusuf

AU - Iheagwaram, Chibuikem

AU - Taha, Amira Mohamed

AU - Diaz, Michael

AU - Ahmed, Ryan

AU - Patel, Pari

AU - Huda, Shahriar Siam

AU - Das, Authoy

AU - M., Triet Nguyen

AU - Huynh, Phat K.

AU - Ansari, Miyaz

AU - Shargo, Ryan

AU - Tao, Ngoc Phuong Hong

AU - Vu, Loc

AU - Rutledge-Jukes, Heath

AU - Lam, Gia Han

AU - Thao, Le Nhat

AU - Thuan, Phan

AU - Vuong, Ngoc-Minh

AU - Van-Phu, Tran

AU - Pham, Chuong

AU - Jain, Nityanand

AU - Nguyen, Dinh

N1 - Conference code: 73

PY - 2024/4/6

Y1 - 2024/4/6

N2 - Background Type A acute aortic intramural hematomas (IMHs), especially with thrombi in the ascending aorta, pose an increased risk of complications relative to Type B. The therapeutic direction for Type A IMH remains contentious. This study contrasts the outcomes of TEVAR and open surgical approaches in managing IMHs. Methods We conducted a single-center, retrospective analysis involving patients diagnosed with either Type A, retrograde A, or Type B IMH who underwent either surgical or endovascular treatments from January 2017 to December 2020. Parameters such as three-year survival, overall mortality, vascular and hemorrhagic events, renal damage, cardiac anomalies, neurological events, and need for re-intervention or readmission were scrutinized. Results Our cohort included 31 patients with IMH who received post-intervention follow-up. The subgroups were categorized into: 11 after Type A surgical treatment (average age: 63 ± 9 years; 55% male), 7 after Type A endovascular treatment (average age: 67 ± 6 years; 57% male), and 13 after Type B endovascular treatment (average age: 64 ± 8 years; 77% male). Notably, the median hospital stay durations for IMH-A, retrograde IMH-A, and IMH-B were 13, 5, and 4 days, respectively. Postoperative complications were markedly prevalent in IMH-A (n=8, 73%) relative to the retrograde IMH-A and IMH-B categories. One and three-year survival rates post-repair were discerned to be 82%/68%, 100%/100%, and 100%/75% for Type A surgical, Type A endovascular, and Type B endovascular approaches, respectively. Conclusions Aortic IMHs are notably linked to aortic dissections, leading to life-threatening outcomes. Despite the traditional preference for surgical remedies in most IMH instances, our data suggests that TEVAR offers a promising, minimally invasive alternative, especially for Type A retrograde and Type B IMHs.

AB - Background Type A acute aortic intramural hematomas (IMHs), especially with thrombi in the ascending aorta, pose an increased risk of complications relative to Type B. The therapeutic direction for Type A IMH remains contentious. This study contrasts the outcomes of TEVAR and open surgical approaches in managing IMHs. Methods We conducted a single-center, retrospective analysis involving patients diagnosed with either Type A, retrograde A, or Type B IMH who underwent either surgical or endovascular treatments from January 2017 to December 2020. Parameters such as three-year survival, overall mortality, vascular and hemorrhagic events, renal damage, cardiac anomalies, neurological events, and need for re-intervention or readmission were scrutinized. Results Our cohort included 31 patients with IMH who received post-intervention follow-up. The subgroups were categorized into: 11 after Type A surgical treatment (average age: 63 ± 9 years; 55% male), 7 after Type A endovascular treatment (average age: 67 ± 6 years; 57% male), and 13 after Type B endovascular treatment (average age: 64 ± 8 years; 77% male). Notably, the median hospital stay durations for IMH-A, retrograde IMH-A, and IMH-B were 13, 5, and 4 days, respectively. Postoperative complications were markedly prevalent in IMH-A (n=8, 73%) relative to the retrograde IMH-A and IMH-B categories. One and three-year survival rates post-repair were discerned to be 82%/68%, 100%/100%, and 100%/75% for Type A surgical, Type A endovascular, and Type B endovascular approaches, respectively. Conclusions Aortic IMHs are notably linked to aortic dissections, leading to life-threatening outcomes. Despite the traditional preference for surgical remedies in most IMH instances, our data suggests that TEVAR offers a promising, minimally invasive alternative, especially for Type A retrograde and Type B IMHs.

KW - TEVAR

KW - intramural hematoma

KW - mortality

KW - Survival analysis

KW - endovascular interventions

U2 - 10.1016/s0735-1097(24)02924-3

DO - 10.1016/s0735-1097(24)02924-3

M3 - Meeting Abstract

SN - 0735-1097

VL - 83

SP - 934

EP - 934

JO - Journal of the American College of Cardiology (JACC)

JF - Journal of the American College of Cardiology (JACC)

IS - 13, Suppl.A

Y2 - 6 April 2024 through 8 April 2024

ER -

Nguyen D, Qureshi Y, Iheagwaram C, Taha AM, Diaz M, Ahmed R et al. Comparative Outcomes of Thoracic Endovascular Aortic Repair (TEVAR) and Surgical Management for Type A and Type B Intramural Hematomas: A Single-Center Retrospective Cohort Study. Journal of the American College of Cardiology (JACC). 2024 Apr 6;83(13, Suppl.A):934-934. doi: 10.1016/s0735-1097(24)02924-3