Jeon Yun-Ho, Bae Chi-Hoon
Department of Thoracic and Cardiovascular Surgery, Catholic University of Daegu School of Medicine.
Korean J Thorac Cardiovasc Surg. 2016 Feb;49(1):15-21. doi: 10.5090/kjtcs.2016.49.1.15. Epub 2016 Feb 5.
We aimed to evaluate the incidence, predictive factors, and impact of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR).
A total of 53 patients who underwent 57 TEVAR operations between 2008 and 2015 were reviewed for the incidence of AKI as defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease risk) consensus criteria. The estimated glomerular filtration rate was determined in the perioperative period. Comorbidities and postoperative outcomes were retrospectively reviewed.
Underlying aortic pathologies included 21 degenerative aortic aneurysms, 20 blunt traumatic aortic injuries, six type B aortic dissections, five type B intramural hematomas, three endoleaks and two miscellaneous diseases. The mean age of the patients was 61.2±17.5 years (range, 15 to 85 years). AKI was identified in 13 (22.8%) of 57 patients. There was an association of preoperative stroke and postoperative paraparesis and paraplegia with AKI. The average intensive care unit (ICU) stay in patients with AKI was significantly longer than in patients without AKI (5.3 vs. 12.7 days, p=0.017). The 30-day mortality rate in patients with AKI was significantly higher than patients without AKI (23.1% vs. 4.5%, p=0.038); however, AKI did not impact long-term survival.
Preoperative stroke and postoperative paraparesis and paraplegia were identified as predictors for AKI. Patients with AKI experienced longer average ICU stays and greater 30-day mortality than those without AKI. Perioperative identification of high-risk patients, as well as nephroprotective strategies to reduce the incidence of AKI, should be considered as important aspects of a successful TEVAR procedure.
我们旨在评估胸主动脉腔内修复术（TEVAR）后急性肾损伤（AKI）的发生率、预测因素及其影响。
回顾了2008年至2015年间共53例接受57次TEVAR手术的患者，根据RIFLE（风险、损伤、衰竭、失功和终末期肾病风险）共识标准定义评估AKI的发生率。在围手术期测定估算肾小球滤过率。对合并症和术后结果进行回顾性分析。
潜在的主动脉病变包括21例退行性主动脉瘤、20例钝性创伤性主动脉损伤、6例B型主动脉夹层、5例B型壁内血肿、3例内漏和2例其他疾病。患者的平均年龄为61.2±17.5岁（范围15至85岁）。57例患者中有13例（22.8%）发生AKI。术前卒中、术后轻截瘫和截瘫与AKI有关。AKI患者的平均重症监护病房（ICU）住院时间明显长于无AKI患者（5.3天对12.7天，p=0.017）。AKI患者的30天死亡率明显高于无AKI患者（23.1%对4.5%，p=0.038）；然而，AKI并不影响长期生存。
术前卒中、术后轻截瘫和截瘫被确定为AKI的预测因素。与无AKI的患者相比，AKI患者的平均ICU住院时间更长，30天死亡率更高。围手术期识别高危患者以及采取肾脏保护策略以降低AKI的发生率，应被视为成功进行TEVAR手术的重要方面。
