Outcomes and risk management in type B aortic dissection patients with acute kidney injury: a concise review

Abstract

Purpose: Type B aortic dissection is a rare but life-threatening disease. Thoracic endovascular aortic repair (TEVAR) was widely used for Type B aortic dissection patients in the last decade due to the lower mortality and morbidity compared with open chest surgical repair (OCSR). AKI in type B aortic dissection is a well-recognized complication and indicates poor short-term and long-term outcome. The objective of this concise review was to identify the risk factors and the impact of AKI on type B aortic dissection patients. Methods and results: A literature search was performed using PubMed, Embase, MEDLINE, and Cochrane Library with the search terms 'type B aortic dissection' and 'acute kidney injury' (AKI), and all English-language literatures published in print or available online from inception through August 2020 were thoroughly reviewed. Studies that reported relative AKI risks and outcomes in type B aortic dissection patient were included. Major mechanisms of AKI in type B aortic dissection included renal hypoperfusion, inflammation response, and the use of contrast medium. Type B aortic dissection patients with AKI significantly had increased hospital stay duration, need of renal replacement therapy, and 30-d and 1-year mortality. Conclusions: AKI in type B aortic dissection is a well-recognized complication and associated with poor short-term and long-term outcome. Early identification of high-risk patients, early diagnosis of AKI, stabilization of the hemodynamic parameters, avoidance of nephrotoxic drugs, and optimization of the use of contrast agents are the major strategies for the reduction of AKI in type B aortic dissection patients.

Develop ment and validation of a prognostic dynamic nomogram for in-hospital mortality in patients with Stanford type B aortic dissection

“…Studies have shown that renal dysfunction increases in-hospital mortality and length of hospital stay and decreases late survival (35)(36)(37)(38). The possible causes of renal dysfunction can be summarized as follows (39)(40)(41): (1) unstable hemodynamic parameters; (2) nephrotoxic drugs and contrast agents are administered to high-risk patients;…”

“…Studies have shown that renal dysfunction increases in-hospital mortality and length of hospital stay and decreases late survival ( 35 – 38 ). The possible causes of renal dysfunction can be summarized as follows ( 39 – 41 ): (1) unstable hemodynamic parameters; (2) nephrotoxic drugs and contrast agents are administered to high-risk patients; (3) some patients with TBAD exhibit renal artery involvement; and (4) on admission, the patient had elevated diastolic blood pressure and fasting blood glucose levels. These results support the findings of this study.…”

Khảo sát một số yếu tố liên quan đến tổn thương thận cấp ở bệnh nhân tách thành động mạch chủ cấp type B được can thiệp đặt stent graft

“…2,3 Tổn thương thận cấp ở bệnh nhân tách thành động mạch chủ cấp type B được can thiệp đặt stent graft là một biến chứng thường gặp với tỷ lệ cao. [4][5][6] Nghiên cứu của nhóm tác giả Jian-ChengZhu và cộng sự tiến hành trong 7 năm với 156 bệnh nhân tách thành ĐMC cấp type B được điều trị can thiệp đặt stent graft cho thấy tỷ lệ tổn thương thận cấp là 30,8%. 7…”

Akut Stanford B típusú aortadissectio konzervatív és invazív terápiájának hosszú távú eredményei Magyarországon

“…Fontos megjegyezni azonban, hogy a TEVAR alatt jelentkező kontrasztanyag-terhelés következtében fellépő vagy a nyitott műtét során előforduló veseperfúziót érintő hemodinamikai változások egyaránt kedvezőtlenek lehetnek a későbbi vesefunkcióra nézve. Jelenleg nincs egyértelmű ajánlás, hogy a vese hosszú távú működésének visszaállítására melyik terápiás eljárás a kedvezőbb, az azonban elmondható, hogy a vesefunkció nagymértékű romlásának korai detektálása, a vérnyomásértékek megfelelő helyreállítása, a nephrotoxicus gyógyszerek elkerülése és a kontrasztanyag dózisának optimalizálása fontos stratégiai lépések a veseelégtelenség csökkentése érdekében [11,12].…”