Prompt recognition of renal malperfusion in type B aortic dissection and the prognosis after endovascular therapy
10.3760/cma.j.cn112434-20230307-00050
- VernacularTitle:Stanford B型主动脉夹层合并肾脏灌注不良的早期识别及介入治疗后转归
- Author:
Xin PU
1
;
Xiaoyong HUANG
;
Tiantian JI
;
Maozhou WANG
;
Fengju LIU
;
Lianjun HUANG
Author Information
1. 首都医科大学附属北京安贞医院介入诊疗科，北京 100029
- Keywords:
Aortic dissection;
Malperfusion syndrome;
Thoracic endovascular repair;
Computed tomography angiography
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2024;40(1):42-49
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the imaging characteristics of Stanford B aortic dissection in aortic CT angiography, in order to explore the possible related factors of aortic dissection combined with renal malperfusion and to analyze the morphological changes in each involved vessel after TEVAR.Methods:From January 2018 to December 2019, totally 148 patients of Stanford B aortic dissection underwent TEVAR in our hospital. The preoperative aortic CTA was analyzed, and all cases complicated with renal malperfusion were determined according to the clinical manifestation, laboratory examination and imaging results. The differences of morphological features between the patients with and without renal malperfusion and the possible correlative factors were analyzed.The different ischemic types of the involved renal arteries were analyzed, and the morphological changes of the involved vessels before and after the operation of TEVAR were compared.Results:The logistic regression analysis showed that the concave configuration of the tear at the renal artery level was the independent risk factor for renal malperfusion (right kidney OR=5.319, P=0.032; left kidney OR=12.879, P=0.007). The diameter of renal artery was the independent protective factor for renal malperfusion (right kidney OR=0.464, P=0.018; left kidney OR=0.685, P=0.016). Compared with preoperative CTA, the diameter of the involved renal artery was significantly enlarged after TEVAR, no matter which type of ischemia. Most of the dynamic ischemia (15/16) was improved after TEVAR; while static and mixed ischemia only partially improved after TEVAR (static 22/36, mixed 11/19) . Conclusion:The concave configuration of the renal artery level, and the diameter of renal artery are associated with renal malperfusion.The malperfusion can be improved in most cases of dynamic ischemia type vessels, while only can be partially improved in static and mixed types vessles.
