Stanford B型主动脉夹层合并肾脏灌注不良的早期识别及介入治疗后转归  

Prompt recognition of renal malperfusion in type B aortic dissection and the prognosis after endovascular therapy

作　　者：濮欣[1] 黄小勇 季甜甜 王茂舟 刘凤菊[4] 黄连军 Pu Xin;Huang Xiaoyong;Ji Tiantian;Wang Maozhou;Liu Fengju;Huang Lianjun(Department of Intervention Diagnosis and Therapy,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Interventional Vascular Surgery,Beijing Aerospace Center Hospital,Beijing 100083,China;Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Ultrasound,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Interventional Radiology and Imaging,Shanghai Deltahealth Hospital,Shanghai 201702,China)

机构地区：[1]首都医科大学附属北京安贞医院介入诊疗科,北京100029 [2]北京航天中心医院介入血管科,北京100083 [3]首都医科大学附属北京安贞医院心外科,北京100029 [4]首都医科大学附属北京安贞医院综合超声科,北京100029 [5]上海德达医院影像与介入科,上海201702

出　　处：《中华胸心血管外科杂志》2024年第1期42-49,共8页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的分析Stanford B型主动脉夹层合并肾脏灌注不良临床干预前后受累肾动脉的形态学变化,及其与靶器官功能变化的相关性。方法回顾性分析2018年1月至2019年12月因Stanford B型主动脉夹层于首都医科大学附属北京安贞医院就诊并行胸主动脉覆膜支架置入术(TEVAR)的连续病例148例,术前行主动脉CTA检查,寻找并发肾脏灌注不良的可能的主动脉CTA形态学特征。分析受累肾动脉不同缺血类型,对比分析TEVAR术前、后受累血管形态学变化和预后。结果肾动脉开口水平呈凹面内膜片是肾脏灌注不良的独立危险因素(右肾OR=5.319,P=0.032;左肾OR=12.879,P=0.007);肾动脉开口内径是肾脏灌注不良的独立保护因素(右肾OR=0.464,P=0.018;左肾OR=0.685,P=0.016);无论是哪种类型的缺血,TEVAR术后肾动脉开口内径均较术前显著扩张;绝大部分动力型缺血TEVAR术后得到明显改善(15/16);静力型和混合型缺血仅有部分TEVAR术后可以得到改善(静力型22/36,混合型11/19)。结论肾动脉开口水平呈凹面内膜片、肾动脉开口内径变窄是Stanford B型主动脉夹层合并肾脏灌注不良综合征的独立危险因素。不同缺血类型的肾动脉在TEVAR术后改善情况不同,绝大多数动力型缺血可以得到明显改善,而静力型和混合型则只有部分得到改善。Objective To analyze the imaging characteristics of Stanford B aortic dissection in aortic CT angiography,in order to explore the possible related factors of aortic dissection combined with renal malperfusion and to analyze the morphological changes in each involved vessel after TEVAR.Methods From January 2018 to December 2019,totally 148 patients of Stanford B aortic dissection underwent TEVAR in our hospital.The preoperative aortic CTA was analyzed,and all cases complicated with renal malperfusion were determined according to the clinical manifestation,laboratory examination and imaging results.The differences of morphological features between the patients with and without renal malperfusion and the possible correlative factors were analyzed.The different ischemic types of the involved renal arteries were analyzed,and the morphological changes of the involved vessels before and after the operation of TEVAR were compared.Results The logistic regression analysis showed that the concave configuration of the tear at the renal artery level was the independent risk factor for renal malperfusion(right kidney OR=5.319,P=0.032;left kidney OR=12.879,P=0.007).The diameter of renal artery was the independent protective factor for renal malperfusion(right kidney OR=0.464,P=0.018;left kidney OR=0.685,P=0.016).Compared with preoperative CTA,the diameter of the involved renal artery was significantly enlarged after TEVAR,no matter which type of ischemia.Most of the dynamic ischemia(15/16)was improved after TEVAR;while static and mixed ischemia only partially improved after TEVAR(static 22/36,mixed 11/19).Conclusion The concave configuration of the renal artery level,and the diameter of renal artery are associated with renal malperfusion.The malperfusion can be improved in most cases of dynamic ischemia type vessels,while only can be partially improved in static and mixed types vessles.

关 键 词：主动脉夹层 灌注不良综合征 胸主动脉覆膜支架置入术 计算机断层摄影血管造影术 

分 类 号：R543.1[医药卫生—心血管疾病] R692[医药卫生—内科学]