Clinical features and prognosis of acute aortic intramural hemorrhage compared with those of acute aortic dissection - A single center experience

The clinical manifestations and natural history of acute aortic intramural hemorrhage are not well characterized. Therefore, we have evaluated the dif ferences in the clinical features and prognosis between acute intramural he morrhage and acute classic aortic dissection. One hundred two consecutive patients with acute aortic syndrome were diagno sed between November 1994 and May 1999. The clinical features, treatment mo dalities and survival of these patients were analyzed. Thirty one of the 102 patients (30%) had intramural hemorrhage and 71 (70%) had aortic dissection. Patients with intramural hemorrhage were older than those with aortic dissection (mean ages 67 and 55 years, respectively) (p < 0.001), and intramural hemorrhage showed a lower proportion of type A tha n did aortic dissection (32% and 58%, respectively) (p = 0.018). The incide nce of severe complications was significantly lower in patients with intram ural hemorrhage than in those with aortic dissection (19% and 27%. respecti vely) (p < 0.001). Mean follow-up duration was 23.1 +/- 16.0 months. The overall death rate for patients with intramural hemorrhage (2 / 31: 6%) tended to be lower than those with aortic dissection (14/71; 20%) (p=0.104 ). The Stanford classification and treatment modalities were not correlated with death. Late follow-up imaging studies in intramural hemorrhage showed partial to complete resolution of intramural hematoma (9/15; 60%). In this study, intramural hemorrhage was fairly common, more frequent among older patients, had a lower proportion of type A, and showed a lower incid ence of severe complications and a more favorable prognosis in terms of mor tality, than aortic dissection.