70
Treatment
Table 30. High-Risk Imaging Features of IMH
For Type A IMH For Type B IMH
• Maximum aortic diameter >45–50 mm • Maximum aortic diameter >47–50 mm
• Hematoma thickness ≥10 mm • Hematoma thickness ≥13 mm
• Focal intimal disruption with ulcer-like
projection involving ascending aorta
or arch
• Focal intimal disruption with ulcer-like
projection involving the descending
thoracic aorta if it develops in acute phase
• Pericardial effusion on admission • Increasing or recurrent pleural effusion
For Both Type A and Type B IMH
• Progression to aortic dissection
• Increasing aortic diameter
• Increasing hematoma thickness
7.6.1. PAU With IMH, Rupture, or Both
COR LOE
Recommendations
1 B-NR 1. In patients with PAU of the aorta with rupture, urgent repair
is recommended.
1 B-NR 2. In patients with PAU of the ascending aorta with associated
IMH, urgent repair is recommended.
2a C-LD 3. In patients with PAU of the aortic arch or descending thoracic
aorta with associated IMH, urgent repair is reasonable.
2b C-LD 4. In patients with PAU of the abdominal aorta with associated
IMH, urgent repair may be considered.
7.6.2. Isolated PAU
COR LOE
Recommendations
1 B-NR 1. In patients with isolated PAU who are symptomatic and have
persistent pain that is clinically correlated with the radiologic
findings, repair is recommended.
2b C-LD 2. In patients with isolated PAU who are asymptomatic but have
high-risk imaging features (Table 31), elective repair may be
considered.
