Stent-graft treatment of dissecting aneurysm in association with aortic intramural hematoma: When should the procedure be performed?

Purpose: To report 2 cases of stent-graft implantation for localized dissec ting aneurysm during the conservative treatment of aortic intramural hemato ma. Case Reports: One patient underwent stent-graft implantation for 2 localize d dissecting aneurysms about 23 months after symptom onset. Computed tomogr aphy (CT) 1 year after the procedure demonstrated aneurysm shrinkage. In th e other patient, a localized dissecting aneurysm was treated about 3 months after symptom onset, even though the intramural hematoma had not resolved. CT scanning 3 months after the procedure demonstrated aneurysm shrinkage, but also revealed poor attachment of the distal stent-graft to the aortic w all due to subsequent resolution of the hematoma. Conclusions: Endograft implantation for treatment of localized dissecting a neurysm associated with aortic intramural hematoma should probably not be p erformed before the hematoma has completely resolved.