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Heart, Lung and Circulation

The Relationship Between Renal Artery Involvement in Stanford B-Type Aortic Dissection and the Short-Term Prognosis: A Single-Centre Retrospective Cohort Study

      Background

      Renal artery involvement has not received sufficient attention despite the fact that aortic computed tomography angiography (CTA) examinations of Stanford B-type aortic dissection patients usually show renal artery involvement [3]. To study the influence of renal artery involvement on aortic dissection, we performed a retrospective study on acute Stanford B-type aortic dissection patients with or without renal artery involvement to investigate its effect on the prognosis of aortic dissection.

      Methods

      A total of 221 patients with acute Stanford-B type aortic dissection between January 2012 and January 2014 were enrolled. The patients were divided into a renal artery involvement group and a non-renal artery involvement group based on aortic computed tomography angiography (CTA) results. The clinical data of the two groups were compared. Univariate analyses and multiple logistic regression analyses were performed to determine risk factors related to in-hospital mortality. The effect of renal artery involvement on the prognosis of Stanford B-type aortic dissection patients was analysed.

      Results

      Among the 221 patients with acute Stanford type-B aortic dissection, 100 patients (45.2%) exhibited renal artery involvement. The percentage of patients with a past history of hypertension in the renal artery involvement group was significantly higher than that in the non-renal artery involvement group (84.0% vs. 74.8%, p = 0.025). The estimated glomerular filtration rate (eGFR), creatinine level, and urea nitrogen level at admission were not significantly different between the renal artery involvement group and the non-renal artery involvement group. The in-hospital mortality rate in the renal artery involvement group was higher than that in the non-renal artery involvement group; the difference in the percentage of in-hospital mortality between these two groups was statistically significant (12.0% vs. 4.1%, p < 0.05). The results of multiple logistic regression analysis showed that renal artery involvement was a risk factor for in-hospital mortality in acute Stanford B-type aortic dissection patients (odds ratio (OR) = 3.536 (1.127 ∼ 11.095)). In the renal artery involvement group, the in-hospital mortality rate in the conservative treatment group was significantly higher than that in the interventional treatment group (30.8% vs. 5.4%, p = 0.001).

      Conclusions

      Although renal artery involvement was not associated with short-term renal function damage, it was a risk factor for in-hospital mortality after acute Stanford B-type aortic dissection.

      Keywords

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      References

        • Starnes B.W.
        • O'Donnell S.D.
        • Gillespie D.L.
        • Goff J.M.
        • Rosa P.
        • Rich N.M.
        Endovascular management of renal ischemia in a patient with acute aortic dissection and renovascular hypertension.
        Ann Vasc Surg. 2002; 16: 368-374
        • Zhang J.
        • Jiang Y.
        • Gao C.
        • Feng J.
        • Wang A.
        Risk factors for hospital death in patients with acute aortic dissection.
        Heart Lung Circ. 2015; 24: 348-353
        • Fattori R.
        • Montgomery D.
        • Lovato L.
        • Kische S.
        • Di Eusanio M.
        • Ince H.
        • et al.
        Survival after endovascular therapy in patients with type B aortic dissection: a report from the International Registry of Acute Aortic Dissection (IRAD).
        JACC Cardiovasc Interv. 2013; 6: 876-882
        • Sentz A.
        The Role of CTA, MRA, and sonography in aortic dissection.
        J Diagn Med Sonogr. 2015; 31: 235-240
        • Nienaber Christoph A.
        • Clough Rachel E.
        Management of acute aortic dissection.
        Lancet. 2015; 385: 800-811
        • Jablonski K.L.
        • Decker E.
        • Perrenoud L.
        • Kendrick J.
        • Chonchol M.
        • Seals D.R.
        • et al.
        Assessment of vascular function in patients with chronic kidney disease.
        J Vis Exp. 2014; 88
        • Ko T.
        • Higashitani M.
        • Sato A.
        • Uemura Y.
        • Norimatsu T.
        • Mahara K.
        • et al.
        Impact of acute kidney injury on early to long-term outcomes in patients who underwent surgery for type A acute aortic dissection.
        Am J Cardiol. 2015; 116: 463-468
        • Naylor A.R.
        • Kolh P.H.
        Endovascular management of rupture in acute type B aortic dissections.
        J Vasc Surg. 2015; 61: 1655