Meta-analysis of 143 reported cases of aortic intramural hematoma

Aortic intramural hematoma (IMH) is a clinical condition that has still not been completely defined. We conducted a meta-analysis of reported cases an d analyzed the demographic profiles, imaging modalities, pathologic sites, and treatment strategies in relation to outcome in 143 patients with IMH, W e performed an English language search of Medline for manuscripts with the keywords "aortic diseases," "aorta AND hematoma," and "intramural hematoma. " Data from 143 reported cases were extracted. IMH of the aorta has a repor ted incidence of 5% to 20% among patients with acute aortic syndromes and a mortality rate of 21%, Most patients were men (61%) and median age was 68 years (range 15 to 88). Hypertension was a predisposing factor in 53% of th e patients, Most patients had chest and/or back pain (80%). Transesophageal echocardiography, computer tomographic scan, or magnetic resonance imaging may be effectively used to diagnose this condition. There is no difference in the overall mortality rates in Stanford type A versus type B patients. patients with Stanford type A IMH who underwent surgery, compared with thos e who underwent medical management, had a significantly better prognosis (1 4% vs 36% mortality, respectively, p <0.02). Patients in Stanford group A w ho received medical treatment had a higher mortality rate than those in gro up B who received medical treatment (36% vs 14% mortality respectively, p < 0.02), In type B patients, medical and surgical outcomes were similar. (C) 2000 by Excerpta Medico, Inc.