Int J Angiol 2017 Dec 24;26(4):267-270. Epub 2017 Aug 24.
Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut.
Intramural hematoma (IMH) is a variant form of aortic dissection characterized by involvement of the aortic media without the presence of an overt intimal flap. Surgical extirpation is the standard of care for type-A IMH in the Western world. However, a conservative approach with anti-impulse therapy has been advocated especially in Japan as a viable alternative. Here, we report a case of an elderly male patient with a history of metastatic stage 4 renal cell carcinoma who was treated with anti-impulse therapy for an acute type-A IMH. Blood pressure stabilization and continuous monitoring resulted in complete resolution of the IMH within 6 days. This report illustrates how immediate medical management in patients with acute type-A IMH who are not surgical candidates can alleviate the progression or even lead to regression as early as 1 week after initiating anti-impulse therapy.