Clinical Analysis Of End-stage Renal Disease With Aortic Dissection

Aortic dissection refers to the process in which blood flows into the middle layer of the aortic wall through the damaged intima and tears along its long axis,thus forming the true and false cavities.It is a very dangerous disease,and its pathogenesis is related to factors such as hypertension and the degeneration of the aortic media membrane.Patients with end-stage renal disease are generally associated with a variety of cardiovascular risk factors such as hypertension,diabetes,arteriosclerosis,abnormal lipid metabolism,abnormal calcium and phosphorus metabolism,etc.Long-term damage to the vascular wall also increases the risk of aortic dissection in such patients,and the prognosis of the patients is relatively poor.Therefore,it is significant to strengthen the understanding of the disease,analyze the relationship between the two diseases and explore the relatively appropriate clinical management plan and treatment mode.Objective : To analyze the risk factors of patients with end-stage renal disease complicated with aortic dissection and to explore the reasonable clinical management and treatment plan for these patients,so as to provide better help and support for the people.Methods: The medical records of patients with end-stage disease complicated with aortic dissection who were admitted to Wuhan Tongji Hospital from January 2010 to December 2020 were collected.In the end,16 males and 6 females were selected.The average age was 48.4 ±12.4 years(29 ～ 72 years),including 8 patients with Stanford type A aortic dissection and 14 patients with Stanford type B aortic dissection.All patients underwent physical examination and blood sampling within 6 hours after admission.The average blood pressure was 158.91±32.16/82.27±18.08 mm Hg,and the highest was230/116 mm Hg.Result: Among the 22 cases,7 patients refused surgery and chose conservative drug treatment,including 4 Stanford type A patients and 3 Stanford type B patients,Stanford type A 4 cases died in the short term after discharge,respectively for 2 days,3 days,7 days,28 days),B(3 cases)died respectively in 34 days,273 days,443 days after discharge,the specific cause of death is unknown,speculated to be the rupture of aortic dissection.The remaining 15 cases received surgical treatment,including 4 cases of open surgery and 11 cases of thoracic endovascular aortic repair(TEVAR).The success rate of the operation was 100%.Within 30 days after operation,3 cases survived,and 1 case died(8d after operation).The causes of death were respiratory insufficiency,septicemia caused by bacterial and fungal infections,etc.In terms of intervention operation,9 cases survived,and 2 cases died,one of which was transferred to the nephrology department after the surgery and died in a month,the cause of death may be the rupture of secondary abdominal aorta dissection,1 case died of sudden cardiac arrest 4 days after the surgery.The 3-year survival rate was 73.33% for those who underwent surgery,and the median survival time for those who refused surgery and died in 3 years was 14(95% CI,0-31.96)days.Conclusion: Patients with end-stage renal disease complicated with aortic dissection tend to be younger.Such patients generally have the situation of insufficient dialysis,disorders of coagulation function,disorders of lipid,calcium,phosphorus and electrolyte metabolism and other risk factors for cardiovascular diseases.Preoperative CRRT,postoperative regularity and adequate dialysis are of great significance for the success of surgery and the prognosis of patients.Surgical procedures including open surgery and interventional surgery(TEVAR)are the first choice for the treatment of end-stage with aortic dissection.