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Imaging features of renal malperfusion in aortic dissection
Open accessAbstract
OBJECTIVES: Malperfusion syndrome accompanying aortic dissection is an independent predictor of death with in-hospital mortality rates >60%. Asymmetrically decreased renal enhancement on computed tomography angiography is often considered evidence of renal malperfusion. We investigated the associations between renal enhancement, baseline laboratory values and the diagnosis of renal malperfusion, as defined by invasive manometry, among patients with aortic dissection. METHODS: In this retrospective cohort study, we included all patients who were referred to our institution with acute dissection and suspected visceral malperfusion between 2010 and 2020. We determined asymmetric renal enhancement by visual assessment and quantitative density measurements of the renal cortex. We collected invasive renal artery pressures during invasive angiography at the aortic root and in the renal arteries. Logistic regression was performed to evaluate independent predictors of renal malperfusion. RESULTS: Among the 161 patients analysed, the majority of patients were male (78%) and had type A dissection (52%). Invasive angiography confirmed suspected renal malperfusion in 83% of patients. Global asymmetric renal enhancement was seen in 42% of patients who did not have renal malperfusion during invasive angiography. Asymmetrically decreased renal enhancement was 65% sensitive and 58% specific for renal malperfusion. Both global [odds ratio (OR) 4.43; 1.20–16.41, P = 0.03] and focal (OR 11.23; 1.12–112.90, P = 0.04) enhancement defects were independent predictors for renal malperfusion. CONCLUSIONS: In patients with aortic dissection, we found that differential enhancement of the kidney as seen on the computed tomography angiography is predictive, but not prescriptive for renal malperfusion. While detection of renal malperfusion is aided by computed tomography angiography, its diagnosis requires close monitoring and often invasive assessment.
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Yu, W., Liang, Y., Gao, J., Xie, D., & Xiong, J. (2024) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-024-02790-z · Cited by 7
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Metadata
- Authors
- van Bakel, P. A. J., Henry, M., Kim, K. M., Yang, B., van Herwaarden, J. A., Alberto Figueroa, C., Patel, H. J., Williams, D. M., & Burris, N. S.
- Affiliations
- University of Michigan (US)
- University Medical Center Utrecht (NL)
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Corresponding author
- Burris, Nicholas S
- ORCID
- Venue
- European Journal of Cardio-Thoracic Surgery
- Publisher
- Oxford University Press (OUP)
- Published
- 2022-01-10
- Volume
- 61
- Issue
- 4
- Pages
- 805-813
- ISSN
- 1010-7940 (ISSN-L)
- 1873-734X
- PMC
- PMC8947793
- OpenAlex
- W4206668352
- Cited by
- 22
- References
- 30
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 7 · 2022: 2
- FWCI
- 1.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- European Journal of Cardio-Thoracic Surgery (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Edward B. Diethrich Professorship
- Phil Jenkins Breakthrough Fund in Cardiac Surgery
- Nicholas S. Burris receives Radiologic Society of North America Research Scholar (RSCH 1801)
- National Institutes of Health (R44 HL145953, TL1TR002242)
- National Center for Advancing Translational Sciences (NCATS) and the Michigan Institute for Clinical & Health Research
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Aortic Thrombus and Embolism
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Connective tissue disorders research
- Keywords
- aortic dissection, visceral malperfusion, CT angiography, type A aortic dissection, diagnostic accuracy
- MeSH terms
- Computed Tomography Angiography, Acute Disease, Aortic Dissection, Female, Humans, Kidney, Male, Retrospective Studies, Treatment Outcome
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