Long-term behavior of aortic intramural hematomas and penetrating ulcers Alan S. Chou, BA, Bulat A. Ziganshin, MD, Paris Charilaou, MD, Maryann Tranquilli,

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Long-term Follow-up of Aortic Intramural Hematomas and Penetrating Ulcers Alan S. Chou, BA, Bulat A. Ziganshin, MD, Paris Charilaou, MD, Maryann Tranquilli,

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Long-term behavior of aortic intramural hematomas and penetrating ulcers Alan S. Chou, BA, Bulat A. Ziganshin, MD, Paris Charilaou, MD, Maryann Tranquilli, RN, John A. Rizzo, PhD, John A. Elefteriades, MD The Journal of Thoracic and Cardiovascular Surgery Volume 151, Issue 2, Pages 361-373.e1 (February 2016) DOI: 10.1016/j.jtcvs.2015.09.012 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Sample radiographic (CT) images demonstrating possible outcomes of imaging follow-up. Left images demonstrate initial state; right images demonstrate progression on follow-up White arrows indicate the site of the lesions. For IMH: resolution (A); unchanged (B); worsening (rapid expansion) (C). For PAU: resolution (D); unchanged (E); worsening (rapid expansion) (F). The Journal of Thoracic and Cardiovascular Surgery 2016 151, 361-373.e1DOI: (10.1016/j.jtcvs.2015.09.012) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Flowchart for hospital course: IMH (A) and PAU (B) patient cohorts. IMH, Intramural hematoma; Tx, treatment; PAU, penetrating atherosclerotic ulcer. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 361-373.e1DOI: (10.1016/j.jtcvs.2015.09.012) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Age and lesion location distribution of IMH and PAU cohorts. A, Histogram of presentation age for patients with IMH and PAU. B, Lesion location for IMH and PAU cohorts. IMH, Intramural hematoma; PAU, penetrating atherosclerotic ulcer. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 361-373.e1DOI: (10.1016/j.jtcvs.2015.09.012) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Behavior of medically and surgically managed IMH and PAU lesions examined via imaging follow-up. A, Presurgical imaging follow-up for 14 patients with IMH. B, Postsurgical imaging follow-up for 17 patients with IMH. C, Presurgical imaging follow-up for 20 patients with PAU. D, Postsurgical imaging follow-up for 15 patients with PAU. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 361-373.e1DOI: (10.1016/j.jtcvs.2015.09.012) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 A, Kaplan–Meier actuarial survivals for all patients in this study. Shaded areas represent standard errors. B, Kaplan–Meier actuarial survivals for IMH and PAU cohorts. Patients with IMH had slightly better survivals than patients with PAU (P = .26). IMH, Intramural hematoma; PAU, penetrating atherosclerotic ulcer. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 361-373.e1DOI: (10.1016/j.jtcvs.2015.09.012) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 A, Kaplan–Meier actuarial survivals, with shaded areas representing standard errors, for patients with nonrupture state IMH comparing survival between initial surgical and initial medical cohorts (P = .10). B, Kaplan–Meier actuarial survivals, with shaded areas representing standard errors, for patients with nonrupture state PAU comparing survival between initial surgical and initial medical cohorts (P = .037). The Journal of Thoracic and Cardiovascular Surgery 2016 151, 361-373.e1DOI: (10.1016/j.jtcvs.2015.09.012) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Kaplan–Meier survivals comparing treatment of patients with nonrupture state. A, IMH. B, PAU. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 361-373.e1DOI: (10.1016/j.jtcvs.2015.09.012) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions