Current Understandings and Approach to the Management of Aortic Intramural Hematomas

Goldberg and colleagues provide an excellent review on a complex topic:  intramural hematomas.  The article has several take-home messages:  one must be very careful in how one defines IMH; its pathogenesis remains unclear; IMH tends to involve a more outer location of the aortic media than aortic dissections (AD) do;  IMH is more likely to rupture externally than AD; risk factors for progression from IMH to AD include aortic diameter and aortic wall thickness; the liberal use of stent grafting for type B IMH is probably unwarranted.  It remains to be proven whether IMH should be treated any differently from AD.  Until then, except under unusual circumstances, the same treatment approach is likely warranted.