TY - JOUR
T1 - International Expert Consensus on the Management of Acute Aortic Type B Intramural Haematoma and Penetrating Ulcer
AU - Francesco Squizzato, Squizzato
AU - D'Oria, Mario
AU - Antonello, Michele
AU - IDEAAS-IMH/PAU Investigators
AU - Trimarchi, Santi
AU - Mani, Kevin
AU - Holden, Andrew
AU - Kölbel, Tilo
AU - Haulon, Stephan
AU - Verhoeven, Eric
AU - Boeckler, Dittmar
AU - Resch, Tim
AU - Azizzadeh, Ali
AU - Lombardi, Joseph V.
AU - Piazza, Michele
AU - Fargion, Aaron Thomas
AU - Zimmermann, Alexander
AU - Wanhainen, Anders
AU - Holden, Andrew
AU - Freyrie, Antonio
AU - Beck, Adam W.
AU - Bachar, Adi
AU - Mees, Barend M.E.
AU - Maurel, Blandine
AU - Nienaber, Cristoph A.
AU - Karkos, Christos
AU - Branzan, Daniela
AU - Schneider, Darren
AU - DeMartino, Randall
AU - Boeckler, Dittmar
AU - Angiletta, Domenico
AU - Tenorio, Emanuel J.R.
AU - Gallitto, Enrico
AU - Verzini, Fabio
AU - Pecoraro, Felice
AU - Benedetto, Filippo
AU - Mussa, Firas F.
AU - Squizzato, Francesco
AU - Grego, Franco
AU - Piffaretti, Gabriele
AU - Gatta, Emanuele
AU - Pratesi, Giovanni
AU - Tinelli, Giovanni
AU - Asciutto, Giuseppe
AU - Leong Tan, Glenn Wei
AU - Verhagen, Hence
AU - Isernia, Giacomo
AU - de Vries, Jean Paul P.M.
AU - Budtz-Lilly, Jacob
AU - Fernández-Noya, Jorge
AU - Sobocinski, Jonathan
N1 - Publisher Copyright: © 2025 The Author(s)
PY - 2025/9/30
Y1 - 2025/9/30
N2 - Objective: The aim of this study was to achieve an international expert consensus on managing acute type B penetrating aortic ulcers (PAUs) and intramural haematomas (IMHs). Methods: A modified Delphi consensus process was employed to develop recommendations for the management of acute type B PAU and IMH. Surveys were sent to international experts practicing in high volume aortic centres worldwide. Statements were voted on using a four point Likert scale in a three round Delphi process. Statements achieving grade A (full agreement 75%) or B (overall agreement 80%, full disagreement < 5%) were included as expert recommendations. Consistency of responses was measured using Cohen's κ and the intraclass correlation coefficient. Results: Eighty three experts were included in the final analysis: 25 statements achieved a consensus, 18 (72%) receiving a grade B strength and seven (28%) a grade A strength. Most statements (97%) had a high consistency classified as grade I or II. The expert panel agreed on the indication for thoracic endovascular aortic repair (TEVAR) for complicated IMH/PAU, defined by rupture or refractory pain/hypertension. Uncomplicated IMH/PAU should be managed conservatively and followed up with serial computed tomography imaging during the acute phase. High risk uncomplicated IMHs are identified by increased haematoma thickness, new onset or increased size of ulcer like projections, or transition to aortic dissection; high risk uncomplicated PAUs are defined by new associated haematoma, PAU width/depth increase, or total aortic diameter increase. Uncomplicated high risk IMH/PAUs may be considered for TEVAR. In performing TEVAR, a proximal sealing length > 20 mm in a site free from haematoma should be achieved, eventually extending in zone 2, with a 0 – 10% oversize. Patency of the left subclavian artery should be maintained. Conclusion: An agreement among international experts was achieved on assessment, management, and follow up of acute type B IMHs and PAUs, addressing areas of inconsistencies or knowledge gaps in existing guidelines.
AB - Objective: The aim of this study was to achieve an international expert consensus on managing acute type B penetrating aortic ulcers (PAUs) and intramural haematomas (IMHs). Methods: A modified Delphi consensus process was employed to develop recommendations for the management of acute type B PAU and IMH. Surveys were sent to international experts practicing in high volume aortic centres worldwide. Statements were voted on using a four point Likert scale in a three round Delphi process. Statements achieving grade A (full agreement 75%) or B (overall agreement 80%, full disagreement < 5%) were included as expert recommendations. Consistency of responses was measured using Cohen's κ and the intraclass correlation coefficient. Results: Eighty three experts were included in the final analysis: 25 statements achieved a consensus, 18 (72%) receiving a grade B strength and seven (28%) a grade A strength. Most statements (97%) had a high consistency classified as grade I or II. The expert panel agreed on the indication for thoracic endovascular aortic repair (TEVAR) for complicated IMH/PAU, defined by rupture or refractory pain/hypertension. Uncomplicated IMH/PAU should be managed conservatively and followed up with serial computed tomography imaging during the acute phase. High risk uncomplicated IMHs are identified by increased haematoma thickness, new onset or increased size of ulcer like projections, or transition to aortic dissection; high risk uncomplicated PAUs are defined by new associated haematoma, PAU width/depth increase, or total aortic diameter increase. Uncomplicated high risk IMH/PAUs may be considered for TEVAR. In performing TEVAR, a proximal sealing length > 20 mm in a site free from haematoma should be achieved, eventually extending in zone 2, with a 0 – 10% oversize. Patency of the left subclavian artery should be maintained. Conclusion: An agreement among international experts was achieved on assessment, management, and follow up of acute type B IMHs and PAUs, addressing areas of inconsistencies or knowledge gaps in existing guidelines.
UR - https://www.scopus.com/pages/publications/105026138712
U2 - 10.1016/j.ejvs.2025.09.045
DO - 10.1016/j.ejvs.2025.09.045
M3 - Article
C2 - 41038380
AN - SCOPUS:105026138712
SN - 1078-5884
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
ER -