Imaging anatomic classification of renal artery involvement in patients with Stanford type A aortic dissection and its postoperative acute renal injury
Jiang Wenxiang, Wu Jinlin, Qiu Juntao, Qiu Jiawei, Fan Shuya, Xie-En Zehua, Zhao Rui, Dai Lu, Gao Wei, Cao Fangfang, Yu Cuntao
Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China
Abstract：Objective A study was conducted to observe the CT angiography imaging anatomy of renal artery involvement in Stanford type A aortic dissection and to explore the clinical value of this classification system.Methods Data of 1331 patients with Stanford type A aortic dissection who underwent surgery at Department of Surgery of Fuwai Hospital of Chinese Academy of Medical Science were collected from January 2010 to December 2017. According to the aortic CT plane scan, the anatomical involvement of one side of the renal artery can be divided into the following five cases: type T, true lumen involved; type F false lumen involved; type B, both lumens involved; type C, crushed intimal flap; and type S, sandwich model. According to the actual CT tomographic observation statistics, bilateral renal artery involvement can be classified as TT, TF, TB, BB, BF, CF, and TS types. The incidences of postoperative AKI and CRRT and the early postoperative mortality of patients with bilateral renal artery involvement were analyzed and compared.Results A total of 1331 Stanford type A aortic dissection patients with bilateral renal artery involvement were grouped according to anatomic classification, as follows: 575 patients had TT type; 352 patients had TF type; 198 patients had TB type; 17 patients had BB type; 30 patients had BF type; 84 patients had CF type; and 75 patients had TS type. The incidences of postoperative AKI of the TT, TF, TB, BB, BF, CF, and TS types were 14.61%(84/575), 22.44%(79/352), 36.36%(72/198), 9/17, 40.0%(12/30), 65.48%(55/84), and 36.0%(27/75), respectively. The incidences of postoperative CRRT of the TT, TF, TB, BB, BF, CF, and TS types were 3.48%(20/575), 6.82%(24/352), 12.12%(24/198), 3/17, 10.00%(3/30), 32.14%(27/84), and 9.33%(7/75), respectively. The early mortality of the TT, TF, TB, BB, BF, CF, and TS types were 4.17%(24/575), 4.26% (15/352), 11.11%(22/198), 2/17, 13.33%(4/30), 17.86%(15/84), and 5.33%(4/75), respectively. Statistically significant differences in the incidence of AKI, CRRT use, and early mortality were found among the various subtypes (all P values<0.01). The incidence of CF type was the highest, followed by BB and BF types.Conclusions Statistically differences in the incidence of AKI, CRRT, and early mortality were found among the anatomical types of renal artery involvement in Stanford type A aortic dissection. The incidences of the above three observation indicators were highest in the CF type, followed by the BB and BF types.
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2021, Vol. 26 
