Background
Thoracic endovascular aortic repair (TEVAR) is gradually becoming a first-line treatment
of complicated acute type B aortic dissection (ATBAD). Interestingly, according to
years of experience in the treatment of ATBAD, we found that patients with ATBAD often
had unexplained noninfectious fever after TEVAR. This study aims to explore its clinical
characteristics and independent risk factors.
Methods
From January 2016 to September 2021, 211 consecutive patients treated electively by
TEVAR for ATBAD were included. The entry tears in all patients originated in the distal
to the left subclavian artery (LSA). All patients were diagnosed with ATBAD for the
first time. The definition of fever in this study was that the body temperature of
patients after TEVAR exceeds 38°C.
Results
A total of 211 patients (53.62 ± 11.34 years, 81% men) were included in the analysis.
To compare patients who did and did not have post-TEVAR fever, they were respectively
classified as the fever group and the nonfever group. Fever was diagnosed in 115 (55%)
patients. Preoperatively, statistical differences were recorded in age (P = 0.023) and red blood cell (P = 0.037). Age <60 years [odds ratio (OR) 2.194, 95% confidence interval (CI) 1.147–4.196,
P = 0.018] and duration of the operation >3 hr (OR 3.586, 95% CI 1.133–11.350, P = 0.03) were positively associated with fever. In the comparison of preoperative
and postoperative experimental data, the changes in white blood cell (P = 0.046) and platelet (P = 0.007) of the 2 groups were significantly different. Hospital stay (P = 0.009) and postoperative hospital stay (P < 0.001) in the fever group were significantly prolonged. There was no difference
in survival in the mid- and long-term follow-up between the 2 groups.
Conclusions
Noninfectious fever occurs in more than half of the patients after TEVAR (115/211,
54.5%). Patients in the fever group are younger. Age <60 years and duration of the
operation >3 hr are independent risk factors for noninfectious fever in patients with
ATBAD after TEVAR fever. Noninfectious fever after TEVAR may lead to prolonged hospital
stay. However, it did not affect mid- and long-term prognosis.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Annals of Vascular SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The international registry of acute aortic dissection (IRAD): new insights into an old disease.JAMA. 2000; 283: 897-903
- 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC).Eur Heart J. 2014; 35: 2873-2926
- Aortic dissections and dissecting aneurysms.Am J Cardiol. 1972; 30: 263-273
- Acute dissecting aneurysms of the aorta: diagnosis and treatment--1979.Am Heart J. 1980; 99: 373-387
- Aortic dissection: anatomy, consequences, and causes.Am Heart J. 1981; 101: 195-214
- Dissecting aneurysm of the aorta: a review of 505 cases.Medicine (Baltimore). 1958; 37: 217-279
- Anatomy, pathology, and classification of aortic dissection.Tech Vasc Interv Radiol. 2021; 24: 100746
- Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial.Circ Cardiovasc Interv. 2013; 6: 407-416
- 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. A report of the American college of cardiology foundation/American heart association task force on practice guidelines, American association for thoracic surgery, American college of radiology, American stroke association, society of cardiovascular anesthesiologists, society for cardiovascular angiography and interventions, society of interventional radiology, society of thoracic surgeons, and society for vascular medicine.Catheter Cardiovasc Interv. 2010; 76: E43-E86
- Endovascular treatment of thoracic aortic diseases: combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries.J Vasc Surg. 2004; 40 (discussion 9-80): 670-679
- Endovascular stent-graft treatment of aortic dissection: determinants of post-interventional outcome.Eur Heart J. 2005; 26: 489-497
- Endovascular management of thoracic dissections.Circulation. 2008; 117: 1460-1473
- Results of a new surgical paradigm: endovascular repair for acute complicated type B aortic dissection.Ann Thorac Surg. 2008; 86 (discussion 93-4): 87-93
- Endovascular stent graft placement in patients with type B aortic dissection: a meta-analysis in China.J Thorac Cardiovasc Surg. 2009; 138: 865-872
- Endovascular stent-graft placement in aortic dissection: a meta-analysis.Eur Heart J. 2006; 27: 489-498
- Aortic dissection manifested as fever of unknown origin.Cardiology. 1991; 78: 78-80
- Aortic dissection presenting as fever of unknown origin.Acta Cardiol. 2001; 56: 37-38
- Pleuritic chest pain and fever: an unusual presentation of aortic dissection.Malays Fam Physician. 2019; 14: 47-52
- Fever due to inflammation in acute aortic dissection: description and proposals for diagnostic and therapeutic management.Rev Esp Cardiol. 2010; 63: 602-606
- Chronic aortic dissection as a cause of fever of unknown origin.South Med J. 2002; 95: 1067-1070
- Fever after percutaneous endovascular stent-graft in type B acute aortic dissection.Intern Med. 2011; 50: 2095-2098
- Non-infectious fever after acute spinal cord injury in the intensive care unit.J Spinal Cord Med. 2019; 42: 310-317
- Society for vascular surgery (SVS) and society of thoracic surgeons (STS) reporting standards for type B aortic dissections.Ann Thorac Surg. 2020; 109: 959-981
- Advanced age is associated with worsened outcomes and a unique genomic response in severely injured patients with hemorrhagic shock.Crit Care. 2015; 19: 77
- Global analyses revealed age-related alterations in innate immune responses after stimulation of pathogen recognition receptors.Aging Cell. 2015; 14: 421-432
- Pyrexia of postimplantation syndrome for patients undergoing (thoracic) endovascular aortic repair.Thorac Cardiovasc Surg. 2015; 63: 126-133
- Predictors associated with an increased prevalence of postimplantation syndrome after thoracic endovascular aortic repair for type B aortic dissection†.Eur J Cardiothorac Surg. 2019; 55: 998-1005
- The neurobiology of the human febrile response.AANA J. 2006; 74: 145-150
- Causes and risk factors for postoperative fever in spine surgery patients.South Med J. 2009; 102: 283-286
- The incidence of and risk factors for postoperative fever after cleft repair surgery in children.J Pediatr Nurs. 2019; 45: e89-e94
- Risk factors for pyrexia after endoscopic submucosal dissection of gastric lesions.Endosc Int Open. 2014; 2: E141-E147
- Predicting postoperative fever and bacterial colonization on packing material following endoscopic endonasal surgery.Eur Arch Otorhinolaryngol. 2017; 274: 167-173
- Postoperative nonpathologic fever after spinal surgery: incidence and risk factor analysis.World Neurosurg. 2017; 103: 78-83
- Intraoperative hypothermia and its clinical outcomes in patients undergoing general anesthesia: National study in China.PLoS One. 2017; 12: e0177221
- Postoperative hyperthermia following off-pump versus on-pump coronary artery bypass surgery.J Cardiothorac Vasc Anesth. 2005; 19: 426-429
- Temperature regulation and energy metabolism in surgical patients.Prog Surg. 1973; 12: 96-127
- Fever in acute pulmonary embolism.Chest. 2000; 117: 39-42
- Fever and deep venous thrombosis. Findings from the RIETE registry.J Thromb Thrombolysis. 2011; 32: 288-292
- Catheter-related right atrial thrombosis.J Vasc Access. 2020; 21: 300-307
- Platelets are versatile cells: new discoveries in hemostasis, thrombosis, immune responses, tumor metastasis and beyond.Crit Rev Clin Lab Sci. 2016; 53: 409-430
- Thrombosis and platelets: an update.Eur Heart J. 2017; 38: 785-791
- Management of cancer-associated thrombosis in patients with thrombocytopenia: guidance from the SSC of the ISTH.J Thromb Haemost. 2018; 16: 1246-1249
- Volume of new-onset thrombus is associated with the development of postimplantation syndrome after endovascular aneurysm repair.J Vasc Surg. 2014; 60: 1140-1145
- Post-implantation syndrome after frozen elephant trunk is associated with the volume of new-onset aortic thrombus.J Thorac Dis. 2021; 13: 4311-4321
Article info
Publication history
Published online: December 05, 2022
Accepted:
November 12,
2022
Received:
July 24,
2022
Footnotes
Conflict of interest: The authors declare no conflicts of interest.
Funding sources: This research was supported by the National Natural Science Foundation of China (81970402 and 81800407).
Author contributions: Xinyang Li designed the analytical strategies, performed data analyses, and wrote the manuscript. Song Wu, Yinde Huang, and Yu Lun performed data analyses. Jian Zhang conceived the research and wrote the manuscript.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
