Aortic Intramural Hematoma Elephant Trunk

Author: Nahush Mokadam, MD; Edward Verrier, MD
Institution: University of Washington
Date Reviewed: March 2014
Learning Domain: Adult Cardiac Surgery
Learning Objective: Acute Aortic Syndromes; Intramural Hematoma
PowerPoint File: Aortic Intramural Hematoma Elephant Trunk

 

Discussion Points for Conference

  • Natural history of expanding intramural hematoma
  • Timing of intervention
  • Comparisons to acute type A dissection
  • Etiologies of perioperative embolic stroke
  • Intraoperative management of complex aortic disease
  • Combined open and endovascular approach

 

Learning Points

  • Expanding intramural hematoma indication for aortic replacement
  • Usually involves more than one tear / reentry point
  • Combined open and endografting is feasible
    • Staged procedure is also option
  • Stroke is common, paraplegia less common
  • Remodeling of aorta can be expected