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.