Min Zhou1, Xueqin Bai2, Liang Cai1, Yong Ding1, Xu Li1, Jiang Lin3, Weiguo Fu1, Zhenyu Shi4. 1. Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, 180 Fenglin Road, 200032, Shanghai, China. 2. Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. 3. Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China. 4. Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, 180 Fenglin Road, 200032, Shanghai, China. Electronic address: shizhenyumax@163.com.
Abstract
PURPOSE: This study investigated the outcomes of endovascular treatment for type B aortic dissection (TBAD) complicated by unilateral renal ischemia and determined the associated predictors. MATERIALS AND METHODS: From January 2010 to December 2016, 44 patients (mean : 54 years of age) with TBAD complicated by a clearly involved unilateral renal artery and a decreased mean density of the unilateral renal parenchyma were enrolled. The volumes and mean densities of each kidney were generated with postprocessing software based on computed tomography angiography. The degree of renal malperfusion (RMD) was defined as the bilateral density difference-to-the mean density ratio of the healthy kidney. The primary outcomes were renal atrophy and renal dysfunction; the secondary outcomes were aorta-related complications. RESULTS: The median follow-up time was 51 months (range: 12-102 months). During follow-up, unilateral renal atrophy and renal dysfunction were observed in 12 patients (27.3%) and 7 patients (15.9%), respectively. RMD showed a moderate predictive value for renal atrophy, with an area under the characteristic curve (AUC) of 0.78. The optimal cutoff value was 27% for RMD in terms of predicting renal atrophy (sensitivity: 91.7%; specificity: 56.2%). Moreover, aorta-related adverse events occurred in 14 patients (31.8%). Preoperative abnormal creatinine level was an independent risk factor for aorta-related complications (odds ratio [OR]: 17.5; P = 0.022) and renal dysfunction (OR: 14.2; P = 0.02). CONCLUSIONS: Preoperative serum creatinine was an effective index used to predict renal and aortic outcomes in this patient cohort. Active imaging follow-up and aggressive endovascular intervention are suggested in patients with RMD >27%.
PURPOSE: This study investigated the outcomes of endovascular treatment for type B aortic dissection (TBAD) complicated by unilateral renal ischemia and determined the associated predictors. MATERIALS AND METHODS: From January 2010 to December 2016, 44 patients (mean : 54 years of age) with TBAD complicated by a clearly involved unilateral renal artery and a decreased mean density of the unilateral renal parenchyma were enrolled. The volumes and mean densities of each kidney were generated with postprocessing software based on computed tomography angiography. The degree of renal malperfusion (RMD) was defined as the bilateral density difference-to-the mean density ratio of the healthy kidney. The primary outcomes were renal atrophy and renal dysfunction; the secondary outcomes were aorta-related complications. RESULTS: The median follow-up time was 51 months (range: 12-102 months). During follow-up, unilateral renal atrophy and renal dysfunction were observed in 12 patients (27.3%) and 7 patients (15.9%), respectively. RMD showed a moderate predictive value for renal atrophy, with an area under the characteristic curve (AUC) of 0.78. The optimal cutoff value was 27% for RMD in terms of predicting renal atrophy (sensitivity: 91.7%; specificity: 56.2%). Moreover, aorta-related adverse events occurred in 14 patients (31.8%). Preoperative abnormal creatinine level was an independent risk factor for aorta-related complications (odds ratio [OR]: 17.5; P = 0.022) and renal dysfunction (OR: 14.2; P = 0.02). CONCLUSIONS: Preoperative serum creatinine was an effective index used to predict renal and aortic outcomes in this patient cohort. Active imaging follow-up and aggressive endovascular intervention are suggested in patients with RMD >27%.