Recommendations for Management of IMH

Referenced studies that support the recommendations are summarized in the Online Data Supplement.

COR	LOE	Recommendations
1	B-NR	1. In patients with complicated (Table 29) acute type A or type B aortic IMH, urgent repair is recommended.1–3
1	B-NR	2. In patients with uncomplicated acute type A IMH, prompt open surgical repair is recommended.1,4–6  In selected patients with uncomplicated acute type A IMH who are at increased operative risk and do not have high-risk imaging features (Table 30), an initial or expectant approach of medical management may be considered.6–12
2b	C-LD
1	B-NR	3. In patients with uncomplicated acute type B IMH, medical therapy as the initial management strategy is recommended.1–3,13
2a	C-LD	4. In patients with type B IMH who require repair of the distal aortic arch or descending thoracic aorta (zones 2–5) and have favorable anatomy, endovascular repair is reasonable when performed by surgeons with endovascular expertise.2,14
2a	C-LD	5. In patients with type B IMH who require repair of the distal aortic arch or descending thoracic aorta (zones 2–5) and have unfavorable anatomy for endovascular repair, open surgical repair is reasonable.2,3
2b	C-LD	6. In patients with uncomplicated type B IMH and high-risk imaging features (Table 30), intervention may be reasonable.13–16