What are the guideline sources, guidelines and references for Aortic intramural hematoma ?
Guideline sources The following summarized guidelines for the evaluation and management of aortic intramural hematoma are prepared by our editorial team based on guidelines from the American Heart Association (AHA/ACC 2022), the American Association for Thoracic Surgery (AATS 2021), the European Society of Cardiology (ESC 2014), and the Society for Cardiovascular Angiography and Interventions (SCAI/STS/SVM/AATS/SCA/AHA/ACR/ACC/ASA/SIR 2010). 1 2 3 4 Guidelines 1. Diagnostic investigations Diagnostic imaging: consider obtaining MRI for characterizing acute intramural hematomas when CT is equivocal. C 2. Medical management Expectant management: As per AHA 2022 guidelines: Consider offering an initial or expectant approach of medical management in selected patients with uncomplicated acute type A intramural hematoma at increased operative risk without https://web.pathway.md/diseases/rec6nnOUwSSuHR8XM 1/3 6/23/23, 2:39 AM Aortic intramural hematoma Pathway high-risk imaging features. C Offer medical therapy as the initial management strategy in patients with uncomplicated acute type B intramural hematoma. B As per ESC 2014 guidelines: Administer initial medical therapy under careful surveillance in patients with type B aortic intramural hematoma. B Administer medical therapy including pain relief and BP control in all patients with aortic intramural hematoma. B 3. Surgical interventions Open surgery: As per AHA 2022 guidelines, perform urgent repair in patients with complicated acute type A or B aortic intramural hematoma. B Show 4 more As per ESC 2014 guidelines: Perform urgent surgery in patients with type A aortic intramural hematoma. B Consider performing surgery in patients with complicated type B aortic intramural hematoma. C Thoracic endovascular aortic repair: As per AHA 2022 guidelines, consider performing endovascular repair by surgeons with endovascular expertise in patients with type B intramural hematoma with favorable anatomy requiring repair of the distal aortic arch or descending thoracic aorta (zones 2-5). C As per ESC 2014 guidelines, consider performing TEVAR in patients with complicated type B aortic intramural hematoma. C 4. Specific circumstances Patients with penetrating atherosclerotic ulcer: Perform urgent repair in patients with penetrating atherosclerotic ulcer of the ascending aorta with associated intramural hematoma. B Consider performing urgent repair in patients with penetrating atherosclerotic ulcer of the aortic arch, descending thoracic aorta, C or abdominal aorta with associated intramural hematoma. C 5. Follow-up and surveillance Surveillance imaging: As per AHA 2022 guidelines: https://web.pathway.md/diseases/rec6nnOUwSSuHR8XM 2/3 6/23/23, 2:39 AM Aortic intramural hematoma Pathway Obtain surveillance CT or MRI after 1 month, 6 months, and 12 months and then, if stable, annually thereafter in patients experienced acute aortic dissection and intramural hematoma managed with medical therapy alone. B Obtain surveillance CT or MRI after 1 month, 6 months, and 12 months and then, if stable, annually thereafter in patients experienced acute aortic dissection and intramural hematoma treated with either open or endovascular aortic repair and having a residual aortic disease. B As per ESC 2014 guidelines, obtain repetitive imaging (CT or MRI) in patients with uncomplicated type B aortic intramural hematoma. B As per AHA 2010 guidelines, consider obtaining surveillance imaging using the schedules established for aortic dissection in patients with aortic intramural hematoma. C References 1. Erbel R, Aboyans V, Boileau C et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology ESC . Eur Heart J. 2014 Nov 1;35 41 2873 926. Open 2. S Christopher Malaisrie, Wilson Y Szeto, Monika Halas et al. 2021 The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection. J Thorac Cardiovasc Surg. 2021 Sep;162 3 735 758.e2. Open 3. Hiratzka LF, Bakris GL, Beckman JA et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010 Apr 6;121 13):e266 369. Open 4. Eric M Isselbacher, Ourania Preventza, James Hamilton Black rd et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Nov 2. 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