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Branch vessel complications are increased in aortic dissection patients with renal insufficiency

Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA

Rajendra H Mehta

University of Michigan, Ann Arbor, MI, USA

Eric M Isselbacher

Massachusetts General Hospital, Boston, MA, USA

Eduardo Bossone

National Research Council, Lecce, Italy

Jeanna V Cooper

University of Michigan, Ann Arbor, MI, USA

Dean E Smith

University of Michigan, Ann Arbor, MI, USA

Jianming Fang

University of Michigan, Ann Arbor, MI, USA

Udo Sechtem

Robert-Bosch Krankenhaus, Stuttgart, Germany

Linda A Pape

University of Massachusetts Hospital, Worcester, MA, USA

Truls Myrmel

Tromsa University Hospital, Tromsa, Norway

Christoph A Nienaber

University of Rostock, Rostock, Germany

Kim A Eagle

University of Michigan, Ann Arbor, MI, USA

Patrick T O'Gara

Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA, pogara{at}partners.org

Morbidity and mortality from aortic dissection remain high despite advances in diagnosis and treatment. Simple markers to identify patients at high risk for non-aortic complications of dissection are lacking. We investigated the effect of renal insufficiency on the presentation, complications, and outcome of patients with acute aortic dissection. We evaluated 638 patients with type A and 365 patients with type B aortic dissection enrolled in the International Registry of Acute Aortic Dissection (IRAD) between January 1996 and December 2000. Chi-squared and Student’s t testing were performed to identify the effect of renal insufficiency on patient presentation, management, and outcome. Patients with renal insufficiency more often required nitroprusside for blood pressure control (type A: 40.7% vs 31.1%, p ¹/4-0.049; type B: 66.7% vs 37.3, p ¹/4-0.0001) and had a greater risk of mesenteric ischemia (type A: 10.7% vs 1.4%, p < 0.0001; type B: 17.7% vs 3.0%, p < 0.0001). In conclusion, aortic dissection patients with renal insufficiency are at increased risk for drug-resistant hypertension and aortic branch vessel compromise. Routine measurement of serum creatinine provides a readily accessible clinical marker for important complications. Upon recognition, renal impairment indicates a need for close monitoring, aggressive blood pressure control, and evaluation of aortic branch vessel circulations.

Key Words: aortic dissection • kidney failure • mortality

Vascular Medicine, Vol. 9, No. 4, 267-270 (2004)
DOI: 10.1191/1358863x04vm561oa


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