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Table 29. Features of Complicated IMH
Feature
• Malperfusion
• Periaortic hematoma
• Pericardial effusion with cardiac tamponade
• Persistent, refractory, or recurrent pain
• Rupture
7.5. Management of IMH
COR LOE
Recommendations
1 B-NR 1. In patients with complicated (Table 29) acute type A or type
B aortic IMH, urgent repair is recommended.
1 B-NR 2. In patients with uncomplicated acute type A IMH, prompt
open surgical repair is recommended.
2b C-LD In selected patients with uncomplicated acute type A IMH
who are at increased operative risk and do not have high-risk
imaging features (Table 30), an initial or expectant approach
of medical management may be considered.
1 B-NR 3. In patients with uncomplicated acute type B IMH, medical
therapy as the initial management strateg y is recommended.
2a C-LD 4. In patients with type B IMH who require repair of the distal
aortic arch or descending thoracic aorta (zones 2–5) and have
favorable anatomy, endovascular repair is reasonable when
performed by surgeons with endovascular expertise.
2a C-LD 5. In patients with type B IMH who require repair of the distal
aortic arch or descending thoracic aorta (zones 2–5) and have
unfavorable anatomy for endovascular repair, open surgical
repair is reasonable.
2b C-LD 6. In patients with uncomplicated type B IMH and high-risk
imaging features (Table 30), intervention may be reasonable.
