MEDICAL THERAPY IN TYPE B AORTIC INTRAMURAL HEMATOMA: A VERY RECENT SINGLE-CENTER EXPERIENCE

Background and Aim: Type B intramural hematoma (TBIMH) management is unclear. Recent guidelines recommend optimal medical therapy (OMT) for stable cases without high-risk signs, closely monitoring evolution with regular imaging follow-ups. OMT and elective TEVAR are suggested for high-risk patients and emergent TEVAR for complicated IMH. In this single-center retrospective series, we report our experience of OMT failure. Methods: From January to June 2024, 4 patients were admitted at our department diagnosed with TBIMH. All of them, without high-risk features or complications, received OMT until unexpected complications occurred, meeting criteria for endovascular repair. Results: One patient underwent surgical treatment after 12 days of OMT due to worsening neurological status and CT evidence of focal contrast enhancements. The remaining patients, initially discharged on medical treatment, developed Type B dissection progression with new symptoms or CT scan worsening after one month. We performed TEVAR for all of them. Post-operative period was uneventful and early follow-up outcomes are good, except for the requiring of rehabilitation for the patient with neurological complications. Conclusions: OMT and observation remains the treatment main-stay for patients with TBIMH. Nevertheless, delayed endovascular repair, subsequent to OMT failure, cannot solve the following complications or sequelae or even death. The question remains: is medical approach safe? Which is the ideal frequency of CT scan control? Further studies, long-term follow-up and adequate sample size may answer.