title: Branch vessel complications are increased in aortic dissection patients with renal insufficiency.
abstract: 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 ttesting 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 = 0.049; type B: 66.7% vs 37.3, p = 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.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Beckman
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
authors.forename: Eric M
authors.initials: EM
authors.lastname: Isselbacher
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.forename: Jeanna V
authors.initials: JV
authors.lastname: Cooper
authors.forename: Dean E
authors.initials: DE
authors.lastname: Smith
authors.forename: Jianming
authors.initials: J
authors.lastname: Fang
authors.forename: Udo
authors.initials: U
authors.lastname: Sechtem
authors.forename: Linda A
authors.initials: LA
authors.lastname: Pape
authors.forename: Truls
authors.initials: T
authors.lastname: Myrmel
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: Patrick T
authors.initials: PT
authors.lastname: O'Gara
mesh_terms: D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000784:Aortic Dissection / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001014:Aortic Aneurysm / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D003971:Diastole / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009599:Nitroprusside / Q000627:therapeutic use; D012042:Registries; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications* / Q000503:physiopathology*; D013599:Systole / Q000187:drug effects
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D015415:Biomarkers; D002121:Calcium Channel Blockers; D009599:Nitroprusside; D003404:Creatinine