| Branch vessel complications are increased in aortic dissection patients with renal insufficiency. | |
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MedLine Citation:
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PMID: 15678618 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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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:
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Title: Vascular medicine (London, England) Volume: 9 ISSN: 1358-863X ISO Abbreviation: Vasc Med Publication Date: 2004 Nov |
Date Detail:
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Created Date: 2005-01-31 Completed Date: 2006-08-31 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 9610930 Medline TA: Vasc Med Country: England |
Other Details:
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Languages: eng Pagination: 267-70 Citation Subset: IM |
Affiliation:
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Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Adrenergic beta-Antagonists / therapeutic use Aged 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 Female Humans Male Middle Aged Nitroprusside / therapeutic use Registries Renal Insufficiency / blood, complications*, physiopathology* Systole / drug effects |
| Grant Support | |
ID/Acronym/Agency:
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K23 HL 04169/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists; 0/Antihypertensive Agents; 0/Biological Markers; 0/Calcium Channel Blockers; 15078-28-1/Nitroprusside; 60-27-5/Creatinine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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