Madjarov Jeko M, Katz Michael G, Crespo-Soto Hector, Madzharov Svetozar, Roush Timothy, Robicsek Francis
1 Department of Cardiovascular Surgery, Sanger Heart & Vascular Institute, Charlotte, NC, USA.
2 Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Vasc Endovascular Surg. 2017 Jul;51(5):342-345. doi: 10.1177/1538574417708133. Epub 2017 May 17.
Acute dissection of thoracic aorta carries a risk of renal ischemia followed by the development of a kidney failure. The optimal surgical and nonsurgical management of these patients, timing of intervention, and the factors predicting renal recovery are not well delineated and remain controversial. We present a case of acute type B thoracic aortic dissection with left kidney ischemia. Evaluation of renal function was performed by the means of internationally accepted Risk, Injury, Failure, Loss of kidney function, End stage kidney disease and Acute Kidney Injury Network classifications for acute kidney injury, renal duplex sonography, and intravascular ultrasound that demonstrated left renal artery dissection with a flap completely compressing the true lumen. The patient underwent thoracic endovascular aortic repair and left renal artery stent and recovered well. Six months later, at the follow-up visit, retrograde type A aortic dissection was found, which was successfully repaired. Reversal of renal ischemia after aortic dissection depends on the precise assessment of renal function and prompt intervention.
胸主动脉急性夹层有导致肾缺血继而发展为肾衰竭的风险。这些患者的最佳手术和非手术治疗、干预时机以及预测肾功能恢复的因素尚未明确界定，仍存在争议。我们报告一例伴有左肾缺血的急性B型胸主动脉夹层病例。通过国际认可的急性肾损伤风险、损伤、衰竭、肾功能丧失、终末期肾病和急性肾损伤网络分类方法、肾双功超声以及血管内超声对肾功能进行评估，结果显示左肾动脉夹层，有一个瓣片完全压迫真腔。该患者接受了胸主动脉腔内修复术和左肾动脉支架置入术，恢复良好。六个月后随访时，发现逆行性A型主动脉夹层，并成功修复。主动脉夹层后肾缺血的逆转取决于对肾功能的精确评估和及时干预。
