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经导管主动脉腔内修复术治疗急性B型主动脉夹层继发肾动脉狭窄的短期预后

Short Term Prognosis of Renal Artery Stenosis Secondary to Acute Type B Aortic Dissection With TEVAR.

作者信息

Li Lei, Wang Maozhou, Li Jinzhang, Guan Xinliang, Xin Pu, Wang Xiaolong, Liu Yuyong, Li Haiyang, Jiang Wenjian, Gong Ming, Zhang Hongjia

机构信息

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.

出版信息

Front Cardiovasc Med. 2021 Apr 23;8:658952. doi: 10.3389/fcvm.2021.658952. eCollection 2021.

Abstract

To determine the effect of renal artery stenosis (RAS) resulting from acute type B aortic dissection (ATBAD) with thoracic endovascular aortic repair (TEVAR) on early prognosis in patients with ATBAD. A total of 129 ATBAD patients in the National Acute Aortic Syndrome Database (AASCN) who underwent TEVAR between 2019 and 2020 were enrolled in our study. Patients were divided into two groups: the RAS group and the non-RAS group. There were 21 RAS patients (16.3%) and 108 non-RAS patients (83.7%) in our cohort. No patient in our cohort died during the 1-month follow-up. There was no significant difference in preoperative creatinine clearance rate (CCr) between the two groups (90.6 ± 46.1 μmol/L in the RAS group vs. 78.7 ± 39.2 μmol/L in the non-RAS group, = 0.303) but the RAS group had a significantly lower estimated glomerular filtration rate (eGFR) than the non-RAS group (83.3 ± 25.0 vs. 101.9 ± 26.9 ml/min, respectively; = 0.028).One month after TEVAR, CCr was significantly higher (99.0 ± 68.1 vs. 78.5 ± 25.8 ml/min, = 0.043) and eGFR (81.7 ± 23.8 vs. 96.0 ± 20.0 ml/min, = 0.017) was significantly lower in the RAS group than in the non-RAS group. In ATBAD, RAS could result in acute kidney injury (AKI) in the early stage after TEVAR. The RAS group had a high incidence of hypertension. These results suggest that patients with RAS may need further treatment.

摘要

为确定急性B型主动脉夹层(ATBAD)伴胸主动脉腔内修复术(TEVAR)导致的肾动脉狭窄(RAS)对ATBAD患者早期预后的影响。纳入国家急性主动脉综合征数据库(AASCN)中2019年至2020年间接受TEVAR的129例ATBAD患者进行研究。患者分为两组:RAS组和非RAS组。本队列中有21例RAS患者(16.3%)和108例非RAS患者(83.7%)。本队列中无患者在1个月随访期间死亡。两组术前肌酐清除率(CCr)无显著差异(RAS组为90.6±46.1μmol/L,非RAS组为78.7±39.2μmol/L,P = 0.303),但RAS组的估计肾小球滤过率(eGFR)显著低于非RAS组(分别为83.3±25.0与101.9±26.9 ml/min;P = 0.028)。TEVAR术后1个月,RAS组的CCr显著更高(99.0±68.1与78.5±25.8 ml/min,P = 0.043),而eGFR(81.7±23.8与96.0±20.0 ml/min,P = 0.017)显著更低。在ATBAD中,RAS可导致TEVAR术后早期急性肾损伤(AKI)。RAS组高血压发病率高。这些结果表明,RAS患者可能需要进一步治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f647/8102698/52865663a0b0/fcvm-08-658952-g0001.jpg

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