Anatomic classification of renal artery involvement in patients with Stanford type A aortic dissection based on CT angiography images

Abstract

Abstract Objective This study was conducted to classify the anatomy of renal artery involvement in Stanford type A aortic dissection based on CT angiography images 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 our hospital from January 2010 to December 2017 were analyzed. According to the aortic CT plane scan, the anatomical involvement of one side of the renal artery was divided into the following five types: type T, true lumen involvement; type F, false lumen involvement; type B, both lumens involvement; type C, crushed intimal flap; and type S, sandwich model. Based on the actual CT tomographic observation statistics, bilateral renal artery involvement was classified as TT, TF, TB, BB, BF, CF, and TS types. The incidence of postoperative AKI and CRRT, as well as early postoperative mortality of patients with bilateral renal artery involvement were analyzed among the patients. Results The 1331 patients with Stanford type A aortic dissection with bilateral renal artery involvement were grouped according to their 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 incidence of postoperative AKI for the TT, TF, TB, BB, BF, CF, and TS types was 14.61% (84/575), 22.44% (79/352), 36.36% (72/198), 52.94% (9/17), 40.0% (12/30), 65.48% (55/84), and 36.0% (27/75), respectively. The incidence of postoperative CRRT for the TT, TF, TB, BB, BF, CF, and TS types was 3.48% (20/575), 6.82% (24/352) ,12.12% (24/198), 17.65%(3/17) , 10.00%(3/30), 32.14 (27/84) , and 9.33% (7/75) , respectively. The early mortality rate for the TT, TF, TB, BB, BF, CF, and TS types was 4.17% (24/575), 4.26% (15/352), 11.11% (22/198), 11.76% (2/17), 13.33% (4/30) , 17.86% (15/84), and 5.33% (4/75), respectively. Analysis of the results revealed statistically significant differences in the incidence of AKI, CRRT use, and early mortality among the identified subtypes (all P values < 0.01). The incidence of CF type was the highest, followed by BB and BF types. Conclusions The incidence of AKI, CRRT, and early mortality was significantly different among the anatomical types of renal artery involvement in Stanford type A aortic dissection. Notably, CF type had the highest incidence followed by types BB and BF.result_1result_2