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血管内动脉瘤修复术(EVAR)和经导管主动脉瓣置换术(TAVR)相关的急性肾损伤。

Endovascular aneurysm repair (EVAR)- and transcatheter aortic valve replacement (TAVR)-associated acute kidney injury.

机构信息

Division of Nephrology, Northwell Health, Hofstra Northwell School of Medicine, Great Neck, New York, USA.

Leicester NIHR Cardiovascular Biomedical Research Unit, University of Leicester, UK.

出版信息

Kidney Int. 2017 Jun;91(6):1312-1323. doi: 10.1016/j.kint.2016.11.030. Epub 2017 Mar 17.

Abstract

Acute kidney injury (AKI) after surgery or intervention is an important complication that may impact mortality, morbidity, and health care costs. Endovascular procedures are now performed routinely for a variety of pathologies that were traditionally treated with open surgery because randomized trials comparing endovascular and open surgery have shown at least equally good results and reduced complication and hospitalization rates with endovascular techniques. However, endovascular procedures have been associated with an increased risk for postoperative AKI, predominantly owing to contrast nephrotoxicity. Over the years, endovascular techniques have progressively been applied for the treatment of complex cardiovascular pathologies, and in recent years, nephrologists have increasingly encountered patients who developed AKI after endovascular aneurysm repair or transcatheter aortic valve replacement. These 2 procedures typically involve high-risk patients who have several established AKI risk factors prior to intervention. Several studies have investigated the incidence, risk factors, and natural course of AKI after endovascular aneurysm repair and transcatheter aortic valve replacement. This review summarizes current data on incidence, risk factors, pathophysiology, prognostic implications, and treatment of AKI associated with endovascular aneurysm replacement and transcatheter aortic valve replacement.

摘要

术后或介入治疗后的急性肾损伤(AKI)是一种重要的并发症,可能会影响死亡率、发病率和医疗保健费用。由于随机试验比较了血管内和开放手术,发现血管内技术至少具有同样好的结果,并降低了并发症和住院率,因此现在常规进行血管内手术来治疗多种传统上需要开放手术治疗的病变。然而,血管内手术与术后 AKI 的风险增加有关,主要是由于造影剂肾毒性。多年来,血管内技术已逐渐应用于复杂心血管病变的治疗,近年来,肾病学家越来越多地遇到在血管内动脉瘤修复或经导管主动脉瓣置换术后发生 AKI 的患者。这 2 种手术通常涉及到高危患者,这些患者在介入前就有几个已确立的 AKI 风险因素。有几项研究调查了血管内动脉瘤修复和经导管主动脉瓣置换术后 AKI 的发生率、危险因素和自然病程。这篇综述总结了与血管内动脉瘤置换和经导管主动脉瓣置换相关的 AKI 的发生率、危险因素、病理生理学、预后意义和治疗的最新数据。

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