Postoperative acute kidney injury after thoracic endovascular aortic repair for acute type B aortic dissection

Takuya Ogami; George J Arnaoutakis; Himanshu J Patel; Chih-Wen Pai; Kim A Eagle; Santi Trimarchi; Derek Serna-Gallegos; Ibrahim Sultan

doi:10.1016/j.jvs.2023.05.055

Postoperative acute kidney injury after thoracic endovascular aortic repair for acute type B aortic dissection

J Vasc Surg. 2023 Oct;78(4):912-919.e1. doi: 10.1016/j.jvs.2023.05.055. Epub 2023 Jun 15.

Authors

Takuya Ogami¹, George J Arnaoutakis², Himanshu J Patel³, Chih-Wen Pai⁴, Kim A Eagle⁴, Santi Trimarchi⁵, Derek Serna-Gallegos⁶, Ibrahim Sultan⁷

Affiliations

¹ Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
² Division of Cardiovascular Surgery, University of Florida Health, Gainesville, FL.
³ Department of Cardiac Surgery, University of Michigan Cardiovascular Center, Ann Arbor, MI.
⁴ Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI.
⁵ Department of Surgery, Vascular Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Milan, Italy.
⁶ Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, MI.
⁷ Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, MI. Electronic address: sultani@upmc.edu.

PMID: 37327951
DOI: 10.1016/j.jvs.2023.05.055

Abstract

Background: Thoracic endovascular aortic repair (TEVAR) has evolved as the standard for treating complicated acute type B aortic dissection (ATBAD). Acute kidney injury (AKI) is a common complication in critically ill patients and is commonly observed in patients with ATBAD. The purpose of the study was to characterize AKI after TEVAR.

Methods: All patients who underwent TEVAR for ATBAD from 2011 through 2021 were identified using the International Registry of Acute Aortic Dissection. The primary end point was AKI. A generalized linear model analysis was performed to identify a factor associated with postoperative AKI.

Results: A total of 630 patients presented with ATBAD and underwent TEVAR. The indication for TEVAR was complicated ATBAD in 64.3%, high-risk uncomplicated ATBAD in 27.6%, and uncomplicated ATBAD in 8.1%. Of 630 patients, 102 (16.2%) developed postoperative AKI (AKI group) and 528 patients (83.8%) did not (non-AKI group). The most common indication for TEVAR was malperfusion (37.5%). In-hospital mortality was significantly higher in the AKI group (18.6% vs 4%; P < .001). Postoperatively, cerebrovascular accident, spinal cord ischemia, limb ischemia, and prolonged ventilation were more commonly observed in the AKI group. The expected mortality was similar at 2 years between the two groups (P = .51). Overall, the preoperative AKI was observed in 95 (15.7%) in the entire cohort consisting of 60 (64.5%) in the AKI group and 35 (6.8%) in the non-AKI group. A history of CKD (odds ratio, 4.6; 95% confidence interval, 1.5-14.1; P = .01) and preoperative AKI (odds ratio, 24.1; 95% confidence interval, 10.6-55.0; P < .001) were independently associated with postoperative AKI.

Conclusions: The incidence of postoperative AKI was 16.2% in patients undergoing TEVAR for ATBAD. Patients with postoperative AKI had a higher rate of in-hospital morbidities and mortality than those without. A history of CKD and preoperative AKI were independently associated with postoperative AKI.

Keywords: Acute aortic dissection; Acute kidney injury; International Registry of Acute Aortic Dissections; Malperfusion; Type B aortic dissection.

Published by Elsevier Inc.

MeSH terms

Acute Kidney Injury* / diagnosis
Acute Kidney Injury* / epidemiology
Acute Kidney Injury* / etiology
Aortic Aneurysm, Thoracic* / complications
Aortic Aneurysm, Thoracic* / diagnostic imaging
Aortic Aneurysm, Thoracic* / surgery
Aortic Dissection* / diagnostic imaging
Aortic Dissection* / surgery
Blood Vessel Prosthesis Implantation* / adverse effects
Endovascular Aneurysm Repair
Endovascular Procedures* / adverse effects
Humans
Postoperative Complications / etiology
Postoperative Complications / surgery
Renal Insufficiency, Chronic* / complications
Retrospective Studies
Risk Factors
Treatment Outcome