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

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

doi:10.3389/fcvm.2021.658952

Cited by 4 publications

(4 citation statements)

References 34 publications

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“…Written informed consent was obtained for all data and specimens in the database from patients or their family members. In its scale the database ranks at the forefront in China, and the data for aortic dissection cover most of the people with aortic dissection in China (Guan et al., 2022 ; Li et al., 2021 ).…”

Section: Methodsmentioning

confidence: 99%

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High preoperative bradykinin level is a risk factor for severe postoperative hypoxaemia in acute aortic dissection surgery

Guan

et al. 2023

Experimental Physiology

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New Findings What is the central question of this study?Hypoxaemia can lead to increased postoperative mortality in patients: what are the independent risk factors for severe hypoxaemia after acute Stanford type A aortic dissection? What is the main finding and its importance?Severe postoperative hypoxaemia was found in 36.4% of patients, and it was determined that high preoperative bradykinin levels and increased BMI were independent predictors of severe postoperative hypoxaemia in patients with acute Stanford type A aortic dissection. For obese patients with high preoperative bradykinin levels, more attention should be paid to preventing severe postoperative hypoxaemia. Abstract Severe hypoxaemia after cardiac surgery is associated with serious complications and a high risk of mortality. The purpose of this study is to investigate the independent risk factors of severe postoperative hypoxaemia in patients with acute Stanford type A aortic dissection. We collected 77 patients with acute Stanford type A aortic dissection who underwent surgical treatment. The primary outcome was severe postoperative hypoxaemia (PaO2/FiO2 ≤ 100 mmHg), and a multivariate logistic regression analysis was performed to assess the independent predictors of risk for this. A mixed‐effects analysis of variance model and a receiver operating characteristic (ROC) curve were generated to evaluate the predictive probabilities of risk factors for severe postoperative hypoxaemia. A total of 36.4% of patients developed severe postoperative hypoxaemia. The multivariate logistic regression analysis identified high preoperative bradykinin level (odds ratio (OR) = 55.918, P < 0.001) and increased body mass index (BMI; OR = 1.292, P = 0.032) as independent predictors of severe postoperative hypoxaemia in patients with acute Stanford type A aortic dissection. The mixed‐effect analysis of variance model and ROC curve indicated that high preoperative bradykinin level and BMI were significant predictors of severe postoperative hypoxaemia (area under the ROC curve = 0.834 and 0.764, respectively). High preoperative bradykinin levels and obesity were independent risk factors for severe postoperative hypoxaemia in patients with acute Stanford type A aortic dissection. For obese patients with high levels of bradykinin before surgery, clinicians should actively take measures to block bradykinin‐mediated inflammatory reactions.

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Section: Methodsmentioning

confidence: 99%

“…In its scale the database ranks at the forefront in China, and the data for aortic dissection cover most of the people with aortic dissection in China (Guan et al, 2022;Li et al, 2021).…”

Section: Patient Populationmentioning

confidence: 99%

High preoperative bradykinin level is a risk factor for severe postoperative hypoxaemia in acute aortic dissection surgery

Guan

et al. 2023

Experimental Physiology

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“…11 Concomitant RAS with TBAD may significantly impair renal function and lead to AKI, especially in the early stages following TEVAR. Li et al 41 showed that TBAD patients with RAS have a significantly lower mean eGFR (81.7 vs. 96.0 mL/min, p = 0.017) than those without RAS. Furthermore, they may benefit from an ancillary procedure during TEVAR to aid renal deterioration.…”

Section: Renal Diseasesmentioning

confidence: 99%

Population risk profile analysis of acute uncomplicated type B aortic dissection patients undergoing thoracic endovascular aortic repair

Al-Tawil

Geragotellis

Jubouri

et al. 2022

Asian Cardiovasc Thorac Ann

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Background Uncomplicated type B aortic dissection (unTBAD) comprises the estimated majority of type B aortic dissection (TBAD), presenting without any of the complications associated with complicated TBAD (coTBAD). Although first-line treatment for coTBAD is thoracic endovascular aortic repair (TEVAR), and despite the fact that TEVAR has proven its safety and effectiveness in the treatment of unTBAD, unTBAD is still being predominantly managed conservatively with medical therapy, with a small proportion of patients being offered TEVAR. Aims The main scope of this review is to highlight the evidence in the literature of the demographic characteristics and associated co-morbidities of unTBAD patients undergoing TEVAR in order to produce a risk stratification system to achieve favourable outcomes. Methods A comprehensive literature search was conducted using multiple electronic databases including PubMed, Ovid, Scopus, and EMBASE. Results Multiple demographic characteristics and associated co-morbidities of unTBAD patients affecting TEVAR outcomes were identified, assessed, and investigated, including age, gender, race, genetics, medical conditions, such as hypertension and diabetes, and lifestyle factors such as smoking. Most factors were associated with increased risks of mortality and morbidity, while others, such as race, were identified as being protective against those when it comes to TEVAR. Conclusion Despite the favourable results yielded by TEVAR in unTBAD, there remains a grey area concerning its management. Thus, it is important to incorporate the demographics and co-morbidities of unTBAD patients’ when into clinical judgement when assessing indications for TEVAR intervention to ensure optimum results can be achieved.

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“…Finally, a recent observational study in 129 individuals that received endovascular repair for acute type B aortic dissection reported that 16.3% of the patients had RAS; these individuals had a higher incidence of AKI and lower eGFR both pre-operatively and 1-month post-operatively than individuals without RAS (81.7 ± 23.8 vs. 96.0 ± 20.0 mL/min, P = 0.017). 98 …”

Section: Thoracic Aortic Dissection and Kidney Diseasementioning

confidence: 99%

Diseases of the Aorta and Kidney Disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Sarafidis

Martens

Saratzis

et al. 2021

Cardiovascular Research

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Chronic kidney disease (CKD) is an independent risk factor for the development of abdominal aortic aneurysm (AAA), as well as for cardiovascular and renal events and all-cause mortality following surgery for AAA or thoracic aortic dissection. In addition, the incidence of acute kidney injury (AKI) after any aortic surgery is particularly high, and this AKI per se is independently associated with future cardiovascular events and mortality. On the other hand, both development of AKI after surgery and the long-term evolution of kidney function differ significantly depending on the type of AAA intervention (open surgery versus the various subtypes of endovascular repair). Current knowledge regarding AAA in the general population may not be always applicable to CKD patients, as they have a high prevalence of co-morbid conditions and elevated risk for periprocedural complications. This summary of a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference group discussion reviews the epidemiology, pathophysiology, diagnosis, and treatment of Diseases of the Aorta in CKD and identifies knowledge gaps, areas of controversy, and priorities for future research.

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

Cited by 4 publications

References 34 publications

High preoperative bradykinin level is a risk factor for severe postoperative hypoxaemia in acute aortic dissection surgery

High preoperative bradykinin level is a risk factor for severe postoperative hypoxaemia in acute aortic dissection surgery

Population risk profile analysis of acute uncomplicated type B aortic dissection patients undergoing thoracic endovascular aortic repair

Diseases of the Aorta and Kidney Disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

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