Balceniuk Mark D, Trakimas Lauren, Aghaie Claudia, Mix Doran, Rasheed Khurram, Seaman Matthew, Ellis Jennifer, Glocker Roan, Doyle Adam, Stoner Michael C
1 Strong Memorial Hospital, University of Rochester, Rochester, NY, USA.
Vasc Endovascular Surg. 2018 Jul;52(5):344-348. doi: 10.1177/1538574418765601. Epub 2018 Mar 25.
Chronic kidney disease (CKD) is a predictor of poor outcomes for patients undergoing endovascular aortic aneurysm repair (EVAR). Anatomic severity grade (ASG) represents a quantitative mechanism for assessing anatomical suitability for endovascular aortic repair. Anatomic severity grade has been correlated with repair outcomes and resource utilization. The purpose of this study was to identify a novel renal perfusion metric as a way to assist ASG with predicting EVAR outcomes.
Retrospective review of a prospectively maintained database identified elective infrarenal aortic aneurysm repair cases. Anatomic grading was undertaken by independent reviewers. Using volumetric software, kidney volume, and a novel measure of kidney functional volume, the volumetric nephrogram (VN) was recorded. Systematic evaluation of the relationship of kidney volume and VN to CKD and ASG was undertaken using linear regression and receiver-operator statistical tools.
A total of 386 cases with patient and anatomic data were identified and graded. Mean age was 72.9 ± 0.4 years. Renal volume <281 mL correlated with CKD (area under the curve [AUC] = .708; P ≤ .0001). Volumetric nephrogram <22.5 HU·L correlated with CKD (AUC = 0.764; P ≤ .0001). High (≥15) ASG scores correlated with both renal volume (AUC = .628; P ≤ .0001) and VN (AUC = .628; P ≤ .0001). Regression analysis demonstrated a strong, inverse relationship between ASG and VN ( R = .95).
These data demonstrate that VN is a strong predictor of CKD in a large database of patients undergoing elective aneurysm repair. We demonstrate an inverse relationship between renal function and ASG that has not been previously described in the literature. Additionally, we have shown that VN complements ASG as a model of overall cardiovascular health and atherosclerotic burden. Outcomes in patients with poor renal function may be related to anatomical issues in addition to well-described systemic ramifications.
慢性肾脏病（CKD）是接受血管腔内主动脉瘤修复术（EVAR）患者预后不良的一个预测指标。解剖严重程度分级（ASG）是评估血管腔内主动脉修复术解剖学适宜性的一种定量方法。解剖严重程度分级与修复结果及资源利用相关。本研究的目的是确定一种新的肾灌注指标，作为辅助ASG预测EVAR结果的一种方法。
对前瞻性维护的数据库进行回顾性分析，确定择期肾下腹主动脉瘤修复病例。由独立评审员进行解剖分级。使用容积软件记录肾脏体积以及一种新的肾脏功能体积测量指标——容积肾图（VN）。使用线性回归和受试者操作统计工具对肾脏体积和VN与CKD及ASG之间的关系进行系统评估。
共确定并分级了386例有患者和解剖数据的病例。平均年龄为72.9±0.4岁。肾脏体积<281 mL与CKD相关（曲线下面积[AUC]=0.708；P≤0.0001）。容积肾图<22.5 HU·L与CKD相关（AUC=0.764；P≤0.0001）。高（≥15）ASG评分与肾脏体积（AUC=0.628；P≤0.0001）和VN（AUC=0.628；P≤0.0001）均相关。回归分析显示ASG与VN之间存在强烈的负相关关系（R=0.9）。
这些数据表明，在接受择期动脉瘤修复的大量患者数据库中，VN是CKD的一个强有力的预测指标。我们证明了肾功能与ASG之间存在一种此前文献中未描述的负相关关系。此外，我们还表明VN作为整体心血管健康和动脉粥样硬化负担的一种模型，对ASG起到补充作用。肾功能不佳患者的预后可能除了与已充分描述的全身影响外，还与解剖学问题有关。
