Objective: To investigate the risk factors associated with acute kidney injury and prognosis in patients with Stanford type B aortic dissection after thoracic endovascular aortic repair (TEVAR).
Methods: The clinical data of 193 patients with Stanford type B aortic dissection undergoing TEVAR from December 2013 to December 2016 in Anhui Provincial Hospital were retrospectively analyzed. The acute kidney injury was diagnosed according to the criteria proposed by Acute Kidney Injury Network (AKIN).
Results: In the 193 patients, acute kidney injury after TEVAR occurred in 36 cases (18.7%). Univariate analysis indicated that the history of diabetes, systolic blood pressure at admission, diastolic blood pressure at admission, dose of contrast agent administered during operation and scope of involvement of the renal artery were significantly related to post-TEVAR acute kidney injury (all P<0.05). Multivariate Logsitic regression analysis demonstrated that the history of diabetes (OR=4.458, 95% CI=1.176–16.897, P=0.028), systolic pressure at admission (OR=1.036, 95% CI=1.011–1.063, P<0.01); dose of contrast agent administered during operation (OR=1.025, 95% CI=1.012–1.038, P<0.01); renal artery involvement (OR=3.130, 95% CI=1.222
–8.017, P=0.017) were independent risk factors for post-TEVAR acute kidney injury. Analysis of the follow-up results showed that the early mortality in patients who developed acute kidney injury was significantly higher than that in patients without acute kidney injury (22.6% vs. 6.3%, χ2=8.00, P<0.005), and the survival rate in patients having a history of diabetes was significantly lower than that in patients without a history of diabetes (P<0.05).
Conclusion: High systolic blood pressure at admission, history of diabetes, dose of contrast agent used and involvement of bilateral renal arteries are closely related to the occurrence of acute kidney injury in patients with Stanford type B aortic dissection after TEVAR. The patients with post-TEVAR acute kidney injury have an increased risk of early death, and the history of diabetes has predictive value for the prognosis of the patients after operation.