Cedars-Sinai Medical Center, Division of Cardiothoracic Surgery, Los Angeles, CA, USA.
J Thorac Cardiovasc Surg. 2010 Dec;140(6 Suppl):S161-7. doi: 10.1016/j.jtcvs.2010.10.014.
The risk of renal failure after thoracic endovascular aortic repair is not widely established. The aim of this study was to assess the incidence and risk factors of renal failure.
Between 1998 and 2008, 175 consecutive patients underwent 210 procedures at 2 tertiary academic institutions. Similar nephroprotective protocols and intravascular ultrasound were used. Retrospective analysis was performed. Generalized linear model was used to identify factors associated with change in postoperative estimated glomerular filtration rate.
Underlying aortic diseases included 103 aneurysms, 72 dissections, 21 transections, and 14 penetrating ulcers. Median preoperative estimated glomerular filtration rate was 65 mL · min(-1) · 1.73 m(-2). Contrast media averaged 108.7 ± 69.8 mL. Median estimated glomerular filtration rates within 48 hours and 30 days were 69 and 67 mL · min(-1) · 1.73 m(-2), respectively. Rates of acute renal dysfunction risk (>25% estimated glomerular filtration rate decrease), acute kidney injury (>50% estimated glomerular filtration rate decrease), acute kidney function failure (>75% estimated glomerular filtration rate decrease), and hemodialysis were 9.8% (19/193), 1.6% (3/193), 0% (0/193), and 0.5% (1/193), respectively. Rates of renal dysfunction at 1 month and 6 months were 13.3% (10/75) and 17.7% (6/34), respectively. Risk factors for acute renal dysfunction were intraoperative hypotension, stroke, sepsis, lengthy procedures, and number of stents; at 1 and 6 months they were increased age, male gender, African American race, diabetes mellitus, chronic pulmonary disease, smoking, and zone 0 to 1 graft deployment. Obesity was nephroprotective.
Thoracic aortic endograft has a significant rate of renal dysfunction; however, it is lower in this cohort than in previous smaller series. Routine use of intravascular ultrasound and reduced contrast may have contributed to lower rates of renal insufficiency.
胸主动脉腔内修复术后发生肾衰竭的风险尚不清楚。本研究旨在评估肾衰竭的发生率和危险因素。
1998 年至 2008 年间，在 2 家三级学术中心连续对 175 例患者进行了 210 次手术。使用了相似的肾脏保护方案和血管内超声。进行了回顾性分析。广义线性模型用于确定与术后估计肾小球滤过率变化相关的因素。
基础主动脉疾病包括 103 例动脉瘤、72 例夹层、21 例撕裂伤和 14 例穿透性溃疡。术前估计肾小球滤过率中位数为 65 mL·min-1·1.73 m-2。造影剂平均用量为 108.7±69.8 mL。术后 48 小时和 30 天的估计肾小球滤过率中位数分别为 69 和 67 mL·min-1·1.73 m-2。急性肾功能障碍风险（估计肾小球滤过率下降>25%）、急性肾损伤（估计肾小球滤过率下降>50%）、急性肾功能衰竭（估计肾小球滤过率下降>75%）和血液透析的发生率分别为 9.8%（19/193）、1.6%（3/193）、0%（0/193）和 0.5%（1/193）。术后 1 个月和 6 个月的肾功能障碍发生率分别为 13.3%（10/75）和 17.7%（6/34）。急性肾功能障碍的危险因素包括术中低血压、中风、脓毒症、手术时间长和支架数量多；术后 1 个月和 6 个月的危险因素为年龄较大、男性、非裔美国人、糖尿病、慢性肺部疾病、吸烟和 0 区至 1 区移植物植入。肥胖对肾脏具有保护作用。
胸主动脉腔内修复术后肾功能障碍发生率较高，但本队列的发生率低于以往较小的研究。常规使用血管内超声和减少造影剂可能有助于降低肾功能不全的发生率。
