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내과적 치료를 받은 대동맥 박리와 대동맥 벽내 혈종 환자들의 자연경과에 관한 다기관 경시적 추적관찰 연구

Title
 내과적 치료를 받은 대동맥 박리와 대동맥 벽내 혈종 환자들의 자연경과에 관한 다기관 경시적 추적관찰 연구
Other Titles
 Multicenter Longitudinal Follow-up Clinical Study Comparing the Natural Course of Medically-Treated Patients with Aortic Dissection and Aortic Intramural Hematoma
Authors
 송재관; 김현숙; 손대원; 김용진; 이두하; 박승우; 김기식; 정남식; 임세중; 하종원; 강덕현; 송종민
Issue Date
2001
Journal Title
 Korean Circulation Journal (순환기)
ISSN
 1738-5520
Citation
 Korean Circulation Journal (순환기), Vol.31(6) : 592~601, 2001
Abstract
Background : Although the same treatment strategy has been applied for patients with aortic intramural hematoma (AIH) as typical aortic dissection (AD), the natural history of AIH with medical treatment is not known clearly. The purposes of this study were to test the hypothesis that absence of direct flow communication through intimal tear in AIH has different impact on clinical course compared with typical AD and to clarify the natural history of AIH. Methods : Total 181 patients of acute aortic pathology (AD/AIH=57/124) were enrolled from 5 institutions. Patients received medical treatment without surgical intervention regardless of the affected site in acute stage, and follow-up imaging studies (FUIS) were performed in 105 patients with AIH. Clinical data of these patients were retrospectively analyzed. Results : Fifty-four patients showed involvement of the ascending aorta (AD/AIH=13/41) and 127 revealed distal pathology (AD/AIH=44/83). Compared to the patients with AD, those with AIH were older regardless of the type and showed higher incidence of pleural effusion and mediastinal hemorrhage. In-hospital mortality of proximal AIH was 7%, which was significantly lower than that of proximal AD (62%) ; mortality of distal AIH was also lower than that of distal AD (1.2 Vs 9%, p<0.05). In proximal AIH, FUIS confirmed resorption of AIH in 67% (24/36) and development of AD in 25% (9/36). In distal AIH, resorption was confirmed in 78% (54/69) and development of AD in 16% (11/69). Conclusions : Patients with AIH showed excellent clinical course and high rate of resorption with medical treatment regardless of the affected site ; typical AD developed only in limited cases. Absence of direct flow communication through intimal tear in AIH might explain more favorable response to medical treatment than typical AD.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/142177
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1. 연구논문 > 1. College of Medicine > Dept. of Internal Medicine
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