General Management Strategy
It was important to obtain control of pain (intravenous opiate
analgesia), heart rate (<60 beats per minute), and blood
pressure (systolic blood pressure between 100 and 120 mmHg)[10][16] . The timing of CTA was as follows: on
admission and every 14 days until the absorption of the ascending aortic
hematoma, CTA examinations were adjusted accordingly in eventful cases.
Hematoma thickening, ulcer-like
projection, aortic dissection and aortic aneurysm development and aortic
rupture were defined as aorta-related adverse events. The indications of
necessary TEVAR were as follows: after the complete absorption of the
ascending aorta hematoma, the intimal lesion could be visualized with
CTA (which indicated the evolution of the IMHA to an ulcer-like
projection, a type B aortic dissection, and an aortic aneurysm). Before
TEVAR, all patients received at least one week of medical treatment (if
not, these patients were excluded) [24]. The concomitant
arch reconstruction methods included the arch debranching procedure,
chimney technique and in situ laser fenestration technology. By
measuring the diameter of the proximal attachment site, the stent was
not oversized by more than 10%. The proximal portion of the stent graft
was implanted in the healthy aorta (arch reconstructive methods were
utilized to create sufficient landing zones), and the landing zone had
to be greater than 2 centimeters in length without a substantial
hematoma or circumferential calcification. In our institution, two stent
devices with proximal bare spring designs were available (Valiant
[Medtronic, Inc, Minneapolis, Minn] and Ankura [Lifetechmed, Inc,
Shenzhen, China]) and we avoided balloon dilation[25][26] . The indications for necessary open surgery
were as follows: uncontrollable symptoms (pericardial effusion,
periaortic hematoma and signs of aortic rupture) and CTA imaging
indicating the evolution of type A aortic dissection.