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Article ; Online: Medical and interventional outcome of dissection of the cervical arteries. Systematic review and meta-analysis.

Pini, Rodolfo / Faggioli, Gianluca / Lodato, Marcello / Campana, Federica / Vacirca, Andrea / Gallitto, Enrico / Gargiulo, Mauro

Journal of vascular surgery

2024

Abstract: Introduction: The management of cervical artery dissections (CAD) is poorly standardized given the scarce number of prospective studies comparing medical and interventional approach to CAD. The aim of the present study is to perform a systematic review ... ...

Abstract	Introduction: The management of cervical artery dissections (CAD) is poorly standardized given the scarce number of prospective studies comparing medical and interventional approach to CAD. The aim of the present study is to perform a systematic review and meta-analysis of studies on the treatments of CAD. Methods: Systematic review and meta-analysis - pre-registered on PROSPERO (CRD42022297512) and performed according to the PRISMA guidelines searching in three different databases (PubMed, Embase and Cochrane Database) - of studies on medical or interventional approach to the CAD. Only prospective studies were selected in order to reduce the risk of bias for the primary meta-analysis. Secondarily retrospective studies were also included. The aim was to assess the rate of stroke and of stroke/death/bleeding (major or intracranial) by Der Simonian-Laird weights of random effects model. Results: After screening 456 articles, 6 prospective and 22 retrospective studies were identified. Two randomized controlled trials and 5 retrospective studies comparing antiplatelet (APT) vs. oral anticoagulant therapy (OAC) for CAD were identified, as well as 4 prospective and 17 retrospective single-arm studies evaluating stenting for CAD. In the meta-analysis of RCTs comparing APT vs OAC, 444 patients were considered and a borderline significant association was identified in terms of stroke/death in APT vs OAC groups (OR 5.6; 95% CI: 0.94-33.38, P=.06, I
Language	English
Publishing date	2024-04-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2024.04.036
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Article ; Online: Patient selection and anatomical considerations for zone 0 endovascular aneurysm arch repair.

Mesnard, Thomas / Vacirca, Andrea / Oderich, Gustavo S / Haulon, Stephan

The Journal of cardiovascular surgery

2023 Volume 64, Issue 1, Page(s) 3–8

Abstract: Endovascular aortic arch repair has been widely used in select patients who are considered high risk for open surgical repair and have suitable anatomy. The anatomical challenges of placement of stent-grafts in the ascending aorta are many, including the ...

Abstract	Endovascular aortic arch repair has been widely used in select patients who are considered high risk for open surgical repair and have suitable anatomy. The anatomical challenges of placement of stent-grafts in the ascending aorta are many, including the curved configuration, short landing zone, proximity to the aortic valve and coronary arteries and need to incorporate the supra-aortic trunks. Stent-graft designs with fenestrations and/or directional branches are applicable to patients who have suitable landing zones in the aorta and supra-aortic trunks, adequate access and absence of significant atheromatous debris. These devices include single and multibranch concepts, which are used in combination or not with cervical debranching procedures. This article summarizes the most commonly used anatomical criterion with currently utilized arch branch stent-grafts.
MeSH term(s)	Humans ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; Stents ; Aortic Aneurysm, Thoracic/diagnostic imaging ; Aortic Aneurysm, Thoracic/surgery ; Patient Selection ; Aortic Aneurysm, Abdominal/surgery ; Endovascular Procedures/adverse effects ; Treatment Outcome ; Prosthesis Design ; Aorta, Thoracic/diagnostic imaging ; Aorta, Thoracic/surgery
Language	English
Publishing date	2023-02-10
Publishing country	Italy
Document type	Journal Article
ZDB-ID	80143-4
ISSN	1827-191X ; 0021-9509
ISSN (online)	1827-191X
ISSN	0021-9509
DOI	10.23736/S0021-9509.22.12591-7
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Article ; Online: The efficacy of CO2 angiography in the endovascular treatment of an acute iliac pseudoaneurysm.

Vacirca, Andrea / Mirandola, Veronica / Faggioli, Gianluca / Pini, Rodolfo / Gargiulo, Mauro

The Journal of cardiovascular surgery

2023 Volume 64, Issue 6, Page(s) 653–656

Abstract: ... CO ... 2 ... angiography has been used extensively for the endovascular treatment of aorto-iliac and femoral-popliteal-tibial pathologies, specifically in patients with chronic kidney disease or allergy to iodinated contrast medium (ICM). However, its ... ...

Abstract	CO<inf>2</inf> angiography has been used extensively for the endovascular treatment of aorto-iliac and femoral-popliteal-tibial pathologies, specifically in patients with chronic kidney disease or allergy to iodinated contrast medium (ICM). However, its use in urgent treatment of an acute pseudoaneurysm has never been described before. We report a case of a 39-year-old woman, allergic to iodine, with a recent kidney transplant, who presented in the emergency room with severe pain in the left iliac fossa. Angio CT-scan showed an acute pseudoaneurysm of the left common iliac artery. She was emergently treated with a stent-graft and CO<inf>2</inf> was used as main contrast medium. The intraoperative angiographies performed with carbon dioxide showed very well the rupture site and the pseudoaneurysm; the latter were more clearly visible with CO<inf>2</inf> compared with ICM. The reported case shows the efficacy of CO<inf>2</inf> as contrast medium also in urgent settings and arterial ruptures. The lower viscosity of CO<inf>2</inf> probably leads to an easier diffusion through the arterial lesion into the pseudoaneurysmal sac. Therefore, in this case the use of carbon dioxide not only guaranteed prevention of massive allergic reaction to iodine and preservation of postoperative renal function, but also resulted in higher image quality in the operating room.
MeSH term(s)	Female ; Humans ; Adult ; Carbon Dioxide ; Aneurysm, False/diagnostic imaging ; Aneurysm, False/surgery ; Ilium ; Angiography ; Contrast Media ; Aorta, Abdominal ; Endovascular Procedures/adverse effects ; Iodine ; Treatment Outcome ; Iliac Artery/diagnostic imaging ; Iliac Artery/surgery
Chemical Substances	Carbon Dioxide (142M471B3J) ; Contrast Media ; Iodine (9679TC07X4)
Language	English
Publishing date	2023-08-01
Publishing country	Italy
Document type	Case Reports ; Journal Article
ZDB-ID	80143-4
ISSN	1827-191X ; 0021-9509
ISSN (online)	1827-191X
ISSN	0021-9509
DOI	10.23736/S0021-9509.23.12735-2
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Article ; Online: Pre-emptive False Lumen Embolization to Prevent Persistent Type II Endoleak in Fenestrated-Branched Endovascular Repair of Post-Dissection Thoracoabdominal Aortic Aneurysms.

Gallitto, Enrico / Faggioli, Gianluca / Poliseno, Carmine / Cappiello, Antonio / Pini, Rodolfo / Vacirca, Andrea / Logiacco, Antonino / Gargiulo, Mauro

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists

2024 , Page(s) 15266028241246656

Abstract: Purpose: The purpose was to describe a technique to promote false lumen (FL) thrombosis in post-dissection thoracoabdominal aortic aneurysms (PD-TAAAs) managed by fenestrated/branched endografting (F/B-EVAR).: Technique: A 5/6Fr-90 cm length sheath ... ...

Abstract	Purpose: The purpose was to describe a technique to promote false lumen (FL) thrombosis in post-dissection thoracoabdominal aortic aneurysms (PD-TAAAs) managed by fenestrated/branched endografting (F/B-EVAR). Technique: A 5/6Fr-90 cm length sheath is advanced from the true lumen (TL) to FL through the most distal entry tear of the infrarenal aorta or iliac arteries. It is parked in the most cranial portion of the FL in the thoracic aorta. Aortic endografts are deployed in the TL excluding all the para-visceral/distal entry tears and target visceral vessels bridging stenting is performed. A selective FL angiography is performed through the 5/6Fr sheath to detect the origin of all segmentary arteries. Embolization of FL is performed from above to below by M-reye pushable coils, obtaining the packaging of FL. After completion angiography, the 5/6Fr sheath is retrieved in external iliac artery and molding ballooning of the distal segment of the aortic/iliac endograft is performed. Between 2019 and 2023, this technique was applied in 11cases with a median number of 73 (interquartile range [IQR=12) coils. Out of 8 (72%) patients with available radiological follow-up at 1 year, 7 exhibited complete FL thrombosis. Conclusions: The FL coiling in PD-TAAAs managed by F/B-EVAR is feasible, safe, and effective to promote the complete FL thrombosis. Clinical impact: Preemptive false lumen embolization is a feasible, safe, and effective technique for preventing persistent type II endoleaks after fenestrated-branched endovascular repair of post-dissection thoracoabdominal aortic aneurysms. This technique may be routinely recommended to promote FL thrombosis and aortic remodeling after FB-EVAR in PD-TAAAs, thereby reducing the incidence of reinterventions during follow-up.
Language	English
Publishing date	2024-04-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2006618-1
ISSN	1545-1550 ; 1526-6028
ISSN (online)	1545-1550
ISSN	1526-6028
DOI	10.1177/15266028241246656
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Zs.A 4547: Show issues

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Article ; Online: The mid-term results of the Carotid Asymptomatic Stenosis (CARAS) observational study.

Pini, Rodolfo / Faggioli, Gianluca / Rocchi, Cristina / Fronterrè, Sara / Lodato, Marcello / Vacirca, Andrea / Gallitto, Enrico / Gargiulo, Mauro

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2024 Volume 33, Issue 2, Page(s) 107508

Abstract: Introduction: Carotid endarterectomy (CEA) in patients with asymptomatic carotid stenosis (ACAS) remains a subject of debate. Current recommendations are based on randomized trials conducted over 20 years ago and improvements in medical therapies may ... ...

Abstract	Introduction: Carotid endarterectomy (CEA) in patients with asymptomatic carotid stenosis (ACAS) remains a subject of debate. Current recommendations are based on randomized trials conducted over 20 years ago and improvements in medical therapies may have reduced the risk of cerebral ischemic events (CIE). This study presents a mid-term analysis of results from an ongoing prospective observational study of ACAS patients to assess their CIE risk in a real-world setting. Methods: This is a prospective observational cohort study of patients with ACAS >60 % (NASCET criteria) identified in a single duplex ultrasonography (DUS) vascular laboratory (trial registered: NCT04825080). Patients were not considered for CEA due to their short life expectancy (<3 year) or absence of signs of plaque vulnerability (ulceration, ipoechogenic core). Patient enrollment started in January 2019 and ended in March 2020 with a targeted sample size of 300 patients.A 5-year follow-up was scheduled. Clinical characteristics, risk factors, and medical therapies were documented, and, when necessary, the best medical therapy (BMT), involving antiplatelet agents, blood pressure control, and statins, was recommended during clinical visits. The primary endpoint was to asses CIEs (including strokes, transient ischemic attacks, amaurosis-fugax) ipsilateral to ACAS along with plaque progression rate and patients survival. Follow-up involved annual clinical visit and carotid DUS examination, complemented by telephone interviews at six-month intervals. Results: The study included 307 patients, with an average age of 80 ± 7 years, of whom 55 % were male. Contralateral stenosis exceeding 60 % was present in 61 (20 %) patients. Seventy-seven percent of patients were on BMT. At a mean follow-up of 41±9 months, 7 ispilateral strokes and 9 TIAs occurred, resulting in 14 CIEs (2 patients experienced both TIA and stroke). According to Kaplan-Meier analysis, the 4-year CIE rate was 6±2 %, with an annual CIE rate of 1.5 %. Fifty-eight (19 %) patients had a stenosis progression which was associated with a higher 4-year estimated CIE rate compared to patients with stable plaque (10.3 % vs 3.2 %, P=.01). Similarly, a contralateral carotid stenosis >60 % was associated with a higher 4-year estimated CIE rate: 11.7 % vs 2.9 %, P=.002. These factors were independently associated with high risk for CIE at the multivariate COX analysis: Hazard Ratio (HR): 3.2; 95 % Confidence Interval: 1.1-9.2 and HR: 3.6; 95 % CI: 1.2-10.5. Conclusion: The mid-term results of this prospective study suggest that the incidence of CIE in ACAS patients should not be underestimated, with plaque progression and contralateral stenosis serving as primary predictors of CIEs.
MeSH term(s)	Humans ; Male ; Aged ; Aged, 80 and over ; Female ; Carotid Stenosis/complications ; Carotid Stenosis/diagnostic imaging ; Carotid Stenosis/therapy ; Constriction, Pathologic/complications ; Prospective Studies ; Cohort Studies ; Disease Progression ; Stroke/etiology ; Stroke/complications ; Endarterectomy, Carotid/adverse effects ; Risk Factors ; Ischemic Attack, Transient/diagnostic imaging ; Ischemic Attack, Transient/epidemiology ; Ischemic Attack, Transient/etiology ; Treatment Outcome
Language	English
Publishing date	2024-01-03
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2023.107508
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Zs.A 3519: Show issues

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Article ; Online: Commentary: Investigating and Predicting the Fate of Infrapopliteal Arterial Disease After Endovascular Treatment.

Faggioli, Gianluca / Abualhin, Mohammad / Vacirca, Andrea / Gargiulo, Mauro

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists

2020 Volume 27, Issue 4, Page(s) 581–583

MeSH term(s)	Angioplasty, Balloon/adverse effects ; Humans ; Popliteal Artery/diagnostic imaging ; Treatment Outcome
Language	English
Publishing date	2020-05-29
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2006618-1
ISSN	1545-1550 ; 1526-6028
ISSN (online)	1545-1550
ISSN	1526-6028
DOI	10.1177/1526602820928087
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Article ; Online: Endovascular Repair of One-hundred Urgent and Emergent free or Contained Thoraco-abdominal Aortic Aneurysms Ruptures. An International Multi-Center Trans-Atlantic experience.

Spath, Paolo / Tsilimparis, Nikolaos / Gallitto, Enrico / Becker, Daniel / Vacirca, Andrea / Berekoven, Bärbel / Panuccio, Giuseppe / Karelis, Angelos / Kahlberg, Andrea / Melissano, Germano / Dias, Nuno / Kölbel, Tilo / Austermann, Martin / Faggioli, Gianluca / Oderich, Gustavo / Gargiulo, Mauro

Annals of surgery

2024

Abstract: Objective: To analyze the outcomes of urgent/emergent endovascular aortic repair of patients with free/contained ruptured thoracoabdominal aortic aneurysms (rTAAA).: Background: Endovascular repair of rTAAA has been scarcely described in emergent ... ...

Abstract	Objective: To analyze the outcomes of urgent/emergent endovascular aortic repair of patients with free/contained ruptured thoracoabdominal aortic aneurysms (rTAAA). Background: Endovascular repair of rTAAA has been scarcely described in emergent setting. Methods: An international multicenter retrospective observational study (ClinicalTrials.govID:NCT05956873) from January-2015 to January-2023 in 6 European and 1 United States Vascular Surgery Centers. Primary end-points were technical success, 30-day and/or in-hospital mortality and follow-up survival. Results: A total of 100 rTAAA patients were included (75 male; mean age 73 y). All patients (86 contained and 14 free ruptures) were symptomatic and treated within 24-hours from diagnosis: multi-branched off-the-shelf devices (Zenith t-branch,Cook Medical Inc.Bjaeverskov,Denmark) in 88 patients, physician-modified endografts in 8, patient-specific device or parallel grafts in two patients each. Primary technical success was achieved in 89 patients and 30-day and/or in-hospital mortality was 24%. Major adverse events (MAEs) occurred in 34% of patients (permanent dialysis and paraplegia in 4 and 8 patients, respectively). No statistical differences were detected in mortality rates between free and contained ruptured patients (43%vs.21%; P =0.075). Multivariate analysis revealed contained rupture favoring technical success (Odd-Ratio10.1;95%Confidence-Interval:3.0-33.6; P =<0.001). MAEs (OR9.4;95%C-I:2.8-30.5; P =<0.001) and pulmonary complications (OR11.3;95%CI:3.0-41.5; P =<0.001) were independent risk factors for 30-day and/or in-hospital mortality. Median follow-up time was 13 months (interquartile range 5-24); 1-year survival rate was 65%. Aneurysm diameter>80 mm (Hazard-Ratio:2.0;95%CI:1.0-30.5; P =0.037), technical failure (HR:2.6;95%CI:1.1-6.5; P =0.045) and pulmonary complications (HR:3.0;95%CI:1.2-7.9; P =0.021) were independent risk factors for follow-up mortality. Conclusion: Endovascular repair of rTAAA shows high technical success; the presence of free rupture alone appear not to correlate with early mortality. Effective prevention/management of post-operative complications is crucial for survival.
Language	English
Publishing date	2024-02-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000006231
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Article ; Online: Technical tips and clinical experience with the Cook Triple inner arch branch stent-graft.

Tenorio, Emanuel R / Vacirca, Andrea / Mesnard, Thomas / Sulzer, Titia / Baghbani-Oskouei, Aidin / Mirza, Aleem K / Huang, Ying / Oderich, Gustavo S

The Journal of cardiovascular surgery

2023 Volume 64, Issue 1, Page(s) 9–17

Abstract: Open surgical repair remains the gold standard for treatment for aortic arch diseases, but these operations can be associated with wide heterogeneity in outcomes and significant morbidity and mortality, particularly in elderly patients with severe ... ...

Abstract	Open surgical repair remains the gold standard for treatment for aortic arch diseases, but these operations can be associated with wide heterogeneity in outcomes and significant morbidity and mortality, particularly in elderly patients with severe comorbidities or those who had prior arch procedures via median sternotomy. Endovascular repair has been introduced as a less invasive alternative to reduce morbidity and mortality associated with open surgical repair. The technique evolved with new device designs using up to three inner branches for incorporation of the supra-aortic trunks. This manuscript summarizes technical tips and clinical experience with the triple inner arch branch stent graft for total endovascular repair of aortic arch pathologies.
MeSH term(s)	Humans ; Aged ; Blood Vessel Prosthesis ; Stents ; Blood Vessel Prosthesis Implantation ; Endovascular Procedures ; Treatment Outcome ; Prosthesis Design ; Aorta, Thoracic/diagnostic imaging ; Aorta, Thoracic/surgery ; Aortic Diseases/surgery ; Aortic Aneurysm, Thoracic/diagnostic imaging ; Aortic Aneurysm, Thoracic/surgery
Language	English
Publishing date	2023-01-04
Publishing country	Italy
Document type	Journal Article
ZDB-ID	80143-4
ISSN	1827-191X ; 0021-9509
ISSN (online)	1827-191X
ISSN	0021-9509
DOI	10.23736/S0021-9509.22.12569-3
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Zs.A 469: Show issues

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Article ; Online: Revascularisation of Chronic Limb Threatening Ischaemia in Patients with no Pedal Arteries Leads to Lower Midterm Limb Salvage.

Vacirca, Andrea / Faggioli, Gianluca / Pini, Alessia / Pini, Rodolfo / Abualhin, Mohammad / Sonetto, Alessia / Spath, Paolo / Gargiulo, Mauro

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery

2023 Volume 65, Issue 6, Page(s) 878–886

Abstract: Objective: Chronic limb threatening ischaemia (CLTI) involving the infragenicular arteries is treated by distal angioplasty or pedal bypass; however, this is not always possible, due to chronically occluded pedal arteries (no patent pedal artery, N-PPA). ...

Abstract	Objective: Chronic limb threatening ischaemia (CLTI) involving the infragenicular arteries is treated by distal angioplasty or pedal bypass; however, this is not always possible, due to chronically occluded pedal arteries (no patent pedal artery, N-PPA). This pattern represents a hurdle to successful revascularisation, which must be limited to the proximal arteries. The aim of the study was to analyse the outcome of patients with CLTI and N-PPA after a proximal revascularisation. Methods: All patients with CLTI submitted to revascularisation in a single centre (2019 - 2020) were analysed. All angiograms were reviewed to identify N-PPA, defined as total obstruction of all pedal arteries. Revascularisation was performed with proximal surgical, endovascular, and hybrid procedures. Early and midterm survival, wound healing, limb salvage, and patency rates were compared between N-PPA and patients with one or more patent pedal artery (PPA). Results: Two hundred and eighteen procedures were performed. One hundred and forty of 218 (64.2%) patients were male, mean age 73.2 ± 10.6 years. The procedure was surgical in 64/218 (29.4%) cases, endovascular in 138/218 (63.3%), and hybrid in 16/218 (7.3%). N-PPA was present in 60/218 (27.5%) cases. Eleven of 60 (18.3%) cases were treated surgically, 43/60 (71.7%) by endovascular and 6/60 (10%) by hybrid procedures. Technical success was similar in the two groups (N-PPA 85% vs. PPA 82.3%, p = .42). At a mean follow up of 24.5 ± 10.2 months, survival (N-PPA 93.7 ± 3.5% vs. PPA 95.3 ± 2.1%, p = .22) and primary patency (N-PPA 53.1 ± 8.1% vs. PPA 55.2 ± 5%, p = .56) were similar. Limb salvage was significantly lower in N-PPA patients (N-PPA 71.4 ± 6.6% vs. PPA 81.5 ± 3.4%, p = .042); N-PPA was an independent predictor of major amputation (hazard ratio [HR] 2.02, 1.07 - 3.82, p = .038) together with age > 73 years (HR 2.32, 1.17 - 4.57, p = .012) and haemodialysis (2.84, 1.48 - 5.43, p = .002). Conclusion: N-PPA is not uncommon in patients with CLTI. This condition does not hamper technical success, primary patency, and midterm survival; however, midterm limb salvage is significantly lower than in patients with PPA. This should be considered in the decision making process.
MeSH term(s)	Humans ; Male ; Middle Aged ; Aged ; Aged, 80 and over ; Female ; Limb Salvage/methods ; Chronic Limb-Threatening Ischemia ; Treatment Outcome ; Peripheral Arterial Disease/diagnostic imaging ; Peripheral Arterial Disease/surgery ; Peripheral Arterial Disease/etiology ; Ischemia/diagnostic imaging ; Ischemia/etiology ; Ischemia/surgery ; Popliteal Artery/surgery ; Risk Factors ; Retrospective Studies ; Endovascular Procedures/adverse effects ; Endovascular Procedures/methods ; Vascular Patency
Language	English
Publishing date	2023-04-05
Publishing country	England
Document type	Journal Article
ZDB-ID	1225869-6
ISSN	1532-2165 ; 1078-5884
ISSN (online)	1532-2165
ISSN	1078-5884
DOI	10.1016/j.ejvs.2023.03.043
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Zs.A 2283: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 381: Show issues

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Article ; Online: Timing of Intervention for Aortic Intramural Hematoma.

Vacirca, Andrea / Dias Neto, Marina / Baghbani-Oskouei, Aidin / Huang, Ying / Tenorio, Emanuel R / Estrera, Anthony / Oderich, Gustavo S

Annals of vascular surgery

2022 Volume 94, Page(s) 14–21

Abstract: Intramural hematoma (IMH) is one of the acute aortic syndromes along with acute aortic dissection and penetrating aortic ulcer. The three conditions can occur alone or in combination with overlapping presentation. Medical, open surgical, and endovascular ...

Abstract	Intramural hematoma (IMH) is one of the acute aortic syndromes along with acute aortic dissection and penetrating aortic ulcer. The three conditions can occur alone or in combination with overlapping presentation. Medical, open surgical, and endovascular treatment is tailored depending on clinical presentation, timing, and location within the aorta. Among patients who present with acute IMH affecting the ascending aorta (Type A), urgent open surgical repair is considered the primary line of treatment in patients who are suitable candidates and unstable. The management of IMH in the descending aorta and aortic arch (Type B) is similar to that applied to treat acute dissections in the same segment. Medical treatment with sequential imaging is recommended in patients with uncomplicated course, and endovascular repair is indicated in patients with rupture, persistent pain, end-organ ischemia, or rapid aortic enlargement. This review discusses the ideal timing for treatment of IMH.
MeSH term(s)	Humans ; Aortic Intramural Hematoma ; Treatment Outcome ; Aortic Diseases/diagnostic imaging ; Aortic Diseases/surgery ; Aortic Diseases/complications ; Aortic Dissection/diagnostic imaging ; Aortic Dissection/surgery ; Hematoma/diagnostic imaging ; Hematoma/surgery ; Aorta, Thoracic/surgery
Language	English
Publishing date	2022-10-26
Publishing country	Netherlands
Document type	Review ; Journal Article
ZDB-ID	1027366-9
ISSN	1615-5947 ; 0890-5096
ISSN (online)	1615-5947
ISSN	0890-5096
DOI	10.1016/j.avsg.2022.09.041
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