Association between different blood supply forms of renal artery and renal atrophy after thoracic endovascular aortic repair for DeBakey type Ⅲ b aortic dissection

  Background  Renal atrophy is a common complication of DeBakey type Ⅲ b aortic dissection after thoracic endovascular aortic repair (TEVAR). Renal artery malperfusion may be a risk factor of renal atrophy.

  Objective  To certify the association between different blood supply forms of renal artery and renal atrophy TEVAR for DeBakey type Ⅲ b aortic dissection and explore the effect of TEVAR on renal artery’s blood supply.

  Methods  From June 2011 to July 2017, 180 patients with DeBakey type Ⅲ b aortic dissection receiving TEVAR in the First Medical Center of Chinese PLA General Hospital, Xinjiang People’s Hospital, Zhongshan People’s Hospital or Henan Chest Hospital were enrolled. The renal artery’s blood supplies were categorized as type T (renal artery’s blood supplied by the true lumen), type B (renal artery’s blood supplied by both lumens with a tear near the renal artery), type D (the intimal flap of the aortic dissection extending into the renal artery), type F (renal artery’s blood supplied by the false lumen). Changes of blood supply from pre- to post-operation were analyzed. Based on the incidence of renal atrophy after receiving TEVAR, patients were divided as renal atrophy group (n=55) and non-renal atrophy group (n=125). Clinical data were compared between the two groups. The deadline for follow-up is September 7, 2020. Cox regression analysis was conducted to determine the independent risk factors of renal atrophy after TEVAR in DeBakey Ⅲ type b aortic dissection.

  Results  The proportions of type B, D, F renal artery’s blood supply transformed to type T after TEVAR were 15.87%, 17.31% and 7.32%. The proportions of male patients (80.00% vs 91.20%, P=0.035) and the smoking history (38.18% vs 55.20%, P=0.035) in the renal atrophy group were lower than those in the non-renal atrophy group, while the median BMI was higher than that in the non-renal atrophy group (26.70 vs 24.69, P=0.013). Compared with type T renal artery’s blood supply, type D (HR=4.361, 95% CI: 2.32-8.213, P=0.006) and type F (HR=2.448, 95% CI: 1.189-5.022, P＝0.020) were independent risk factors of renal atrophy after TEVAR for DeBakey type Ⅲ b aortic dissection by multi-factor regression analysis.

  Conclusion  The renal artery’s blood supply is associated with renal atrophy after TEVAR for DeBakey type Ⅲ b aortic dissection. The renal artery with type D blood supply presents the highest risk of renal atrophy. TEVAR alone cannot effectively modify the abnormal blood supply of the renal artery.