BACKGROUND: Intramural hematomas (IMHs) are reported to dynamically evolve into 
different clinical outcomes ranging from regression to aortic rupture, but no 
practice guidelines are available in China.
OBJECTIVE: To determine the evolution of IMHs after long-term follow-up and to 
identify the predictive factors of IMH outcomes in the Chinese population.
METHODS: A total of 123 IMH patients with clinical and imaging follow-up data 
were retrospectively studied. The primary endpoints were aortic disease-related 
death, aortic dissection, penetrating aortic ulcer (PAU), thickening of the 
aortic hematoma and aortic complications requiring surgical or endovascular 
treatment.
RESULTS: All 123 IMH patients were monitored clinically. The follow-up duration 
ranged from 1.4 to 107 months (median, 20 months). Thirty-nine patients had type 
A IMH, and 84 had type B. The multivariate analysis showed that a baseline 
MAD ≥ 44.75 mm (2.9% vs 61.4%, P < 0.001) and acute PAUs (2.9% vs 34.1%, 
P = 0.008) were independent predictors of aorta-related events.
CONCLUSIONS: Medication and short-term imaging are recommended for Chinese IMH 
patients with a hematoma thickness < 10.45 mm and a baseline MAD < 44.75 mm. 
Rigorous medical observation should also be performed during the acute phase of 
IMH.