Document Detail

Branch vessel complications are increased in aortic dissection patients with renal insufficiency.
MedLine Citation:
PMID:  15678618     Owner:  NLM     Status:  MEDLINE    
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.
Joshua A Beckman; Rajendra H Mehta; Eric M Isselbacher; Eduardo Bossone; Jeanna V Cooper; Dean E Smith; Jianming Fang; Udo Sechtem; Linda A Pape; Truls Myrmel; Christoph A Nienaber; Kim A Eagle; Patrick T O'Gara
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Vascular medicine (London, England)     Volume:  9     ISSN:  1358-863X     ISO Abbreviation:  Vasc Med     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2005-01-31     Completed Date:  2006-08-31     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  9610930     Medline TA:  Vasc Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  267-70     Citation Subset:  IM    
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
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MeSH Terms
Acute Disease
Adrenergic beta-Antagonists / therapeutic use
Aneurysm, Dissecting / blood,  complications,  diagnosis*,  drug therapy
Antihypertensive Agents / therapeutic use
Aortic Aneurysm / blood,  complications,  diagnosis*,  drug therapy
Biological Markers / blood
Blood Pressure / drug effects
Calcium Channel Blockers / therapeutic use
Creatinine / blood
Diastole / drug effects
Middle Aged
Nitroprusside / therapeutic use
Renal Insufficiency / blood,  complications*,  physiopathology*
Systole / drug effects
Grant Support
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Antihypertensive Agents; 0/Biological Markers; 0/Calcium Channel Blockers; 15078-28-1/Nitroprusside; 60-27-5/Creatinine

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