Clinical study on noninfectious fever of endovascular aortic repair_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QIAN Zhengyue ¹ , FU Yao ¹ , ZHOU Wenbo ¹ ,  MA Bingbing ²

1. Department of Pharmacy, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, Jiangshu, P. R. China;
2. Department of Vascular Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, Jiangshu, P. R. China;

Corresponding author：

MA Bingbing, Email: jsmabingbing@163.com

Keywords：

Endovascular aortic repair; endovascular aortic repair; noninfectious fever; antibiotics

DOI：

10.7507/1007-4848.202402025

Video：

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Objective To analyze the clinical characteristics and risk factors of noninfectious fever after endovascular repair of aortic dilatation diseases, and explore the management strategy. Methods We reviewed 468 patients who received endovascular aortic repair from January 2021 to October 2023. The patients who were selected were classified into a febrile group and an afebrile group according the fever after operation. The fever data were analyzed, and the demographics, operative data were researched to sieve out the correlation factors. Logistic regression analysis was conducted for the risk factors of postoperative fever if the P value≤0.05 in the univariate analysis, and receiver operating characteristic curve (ROC) was used to analyze the predictive indexes of postoperative noninfectious fever. Results 75.08% (229/305) patients had noninfectious fever after aortic repair and 98.25% of them had fever within 2 days. There were 229 patients in the febrile group, mean age 65 (53.0,73.0) years (83.4% males , and 76 patients in the afebrile group, mean age 71(65.0,76.7) years(84.2% males). Univariate analysis showed that the number of patients with coronary heart disease, using statins before operation and aortic aneurysm in the febrile group were significantly lower than those in the afebrile group, and patients were younger in the febrile group. The logistic regression showed that age, surgical site, type of disease, preoperative hyperthermia, type of stent were positively correlated with noninfectious fever, while statin use was negatively associated with noninfectious fever. And age, surgical site, preoperative hyperthermia and stent type were analyzed by means of ROC curve (P<0.01). Conclusion Noninfectious fever is very common after aortic repair. The relationship between fever and infection should be comprehensively judged according to the risk factors of noninfectious fever and the disease status to promote rational use of antibiotics.

1.	Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College Of Cardiology Joint Committee on clinical practice guidelines. Circulation, 2022, 146(24): e334-e482.
2.	中华医学会心血管病学分会大血管学组, 中国医师协会心血管内科医师分会指南与共识工作委员会. 胸主动脉腔内治疗围手术期管理中国专家共识. 中华医学杂志, 2019, 99(32): 2489-2496.
3.	Senkulak T, Oberhuber A, Yordanov M, et al. Fever management after TEVAR in patients with aortic dissection. Zentralbl Chir, 2022, Online ahead of print.
4.	Li X, Wu S, Huang Y, et al. Clinical characteristics and risk factors of noninfectious fever after thoracic endovascular aortic repair of acute type B aortic dissection. Ann Vasc Surg, 2023, 91: 145-154.
5.	向军, 何玲, 李东林, 等. 胸主动脉腔内修复术后全身炎症反应综合征的危险因素分析. 临床心血管病杂志, 2021, 37(5): 468-472.
6.	Oddi FM, Vacca F, Ciattaglia R, et al. Polyester stent graft devices and higher risk of post-implantation syndrome after EVAR: single-center analysis of 367 patients. Ann Vasc Surg, 2021, 75: 455-460.
7.	Soares Ferreira R, Oliveira-Pinto J, Ultee K, et al. Long term outcomes of post-implantation syndrome after endovascular aneurysm repair. Eur J Vasc Endovasc Surg, 2021, 62(4): 561-568.
8.	Narayan M, Medinilla SP. Fever in the postoperative patient. Emerg Med Clin North Am, 2013, 31(4): 1045-1058.
9.	Nwafor IA, Eze JC. Post-operative fever (POF) after cardiac surgery in a low- and middle-income-country: 7-year institutional experience. Cardiol Young, 2021, 31(3): 352-357.
10.	Yu D, Yan J, Zeng H. Fever after percutaneous endovascular stent-graft in type B acute aortic dissection. Intern Med, 2011, 50(19): 2095-2098.
11.	Zhu Y, Luo S, Ding H, et al. 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(5): 998-1005.
12.	Sano M, Anzai J. The molecular mechanisms contributing to the pathophysiology of systemic inflammatory response after acute aortic dissection. Nihon Rinsho Meneki Gakkai Kaishi, 2016, 39(2): 91-95.
13.	Chatzelas DA, Pitoulias AG, Telakis ZC, et al. Incidence and risk factors of postimplantation syndrome after elective endovascular aortic aneurysm repair. Int Angiol, 2022, 41(3): 196-204.
14.	Nana P, Spanos K, Dakis K, et al. Factors associated with noninfectious fever after endovascular aortic aneurysm repair. J Endovasc Ther, 2022, 29(5): 739-745.
15.	Gerasimidis T, Sfyroeras G, Trellopoulos G, et al. Impact of endograft material on the inflammatory response after elective endovascular abdominal aortic aneurysm repair. Angiol, 2005, 56(6): 743-753.
16.	Koushki K, Shahbaz SK, Mashayekhi K, et al. Anti-inflammatory action of statins in cardiovascular disease: the role of inflammasome and toll-like receptor pathways. Clin Rev Allergy Immunol, 2021, 60(2): 175-199.
17.	Greca E, Kacimi O, Poudel S, et al. Immunomodulatory effect of different statin regimens on regulatory T-cells in patients with acute coronary syndrome: A systematic review and network meta-analysis of randomized clinical trials. Eur Heart J Cardiovasc Pharmacother, 2023, 9(2): 122-128.
18.	Satny M, Hubacek JA, Vrablik M. Statins and inflammation. Curr Atheroscler Rep, 2021, 23(12): 80.
19.	Myasoedova E, Karmacharya P, Duarte-Garcia A, et al. Effect of statin use on the risk of rheumatoid arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum, 2020, 50(6): 1348-1356.
20.	Pratesi C, Esposito D, Apostolou D, et al. Guidelines on the management of abdominal aortic aneurysms: Updates from the Italian Society of Vascular and Endovascular Surgery (SICVE). J Cardiovasc Surg (Torino), 2022, 63(3): 328-352.
21.	谢年谨, 罗淞元, 薛凌, 等. 预防性抗生素在导管室进行完全经皮穿刺主动脉覆膜支架植入术的应用. 南方医科大学学报, 2015, 35(4): 578-582.
22.	Akin I, Nienaber CA, Kische S, et al. Effect of antibiotic treatment in patients with postimplantation syndrome after aortic stent placement. Rev Esp Cardiol, 2009, 62(12): 1365-1372.

1. Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College Of Cardiology Joint Committee on clinical practice guidelines. Circulation, 2022, 146(24): e334-e482.
2. 中华医学会心血管病学分会大血管学组, 中国医师协会心血管内科医师分会指南与共识工作委员会. 胸主动脉腔内治疗围手术期管理中国专家共识. 中华医学杂志, 2019, 99(32): 2489-2496.
3. Senkulak T, Oberhuber A, Yordanov M, et al. Fever management after TEVAR in patients with aortic dissection. Zentralbl Chir, 2022, Online ahead of print.
4. Li X, Wu S, Huang Y, et al. Clinical characteristics and risk factors of noninfectious fever after thoracic endovascular aortic repair of acute type B aortic dissection. Ann Vasc Surg, 2023, 91: 145-154.
5. 向军, 何玲, 李东林, 等. 胸主动脉腔内修复术后全身炎症反应综合征的危险因素分析. 临床心血管病杂志, 2021, 37(5): 468-472.
6. Oddi FM, Vacca F, Ciattaglia R, et al. Polyester stent graft devices and higher risk of post-implantation syndrome after EVAR: single-center analysis of 367 patients. Ann Vasc Surg, 2021, 75: 455-460.
7. Soares Ferreira R, Oliveira-Pinto J, Ultee K, et al. Long term outcomes of post-implantation syndrome after endovascular aneurysm repair. Eur J Vasc Endovasc Surg, 2021, 62(4): 561-568.
8. Narayan M, Medinilla SP. Fever in the postoperative patient. Emerg Med Clin North Am, 2013, 31(4): 1045-1058.
9. Nwafor IA, Eze JC. Post-operative fever (POF) after cardiac surgery in a low- and middle-income-country: 7-year institutional experience. Cardiol Young, 2021, 31(3): 352-357.
10. Yu D, Yan J, Zeng H. Fever after percutaneous endovascular stent-graft in type B acute aortic dissection. Intern Med, 2011, 50(19): 2095-2098.
11. Zhu Y, Luo S, Ding H, et al. 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(5): 998-1005.
12. Sano M, Anzai J. The molecular mechanisms contributing to the pathophysiology of systemic inflammatory response after acute aortic dissection. Nihon Rinsho Meneki Gakkai Kaishi, 2016, 39(2): 91-95.
13. Chatzelas DA, Pitoulias AG, Telakis ZC, et al. Incidence and risk factors of postimplantation syndrome after elective endovascular aortic aneurysm repair. Int Angiol, 2022, 41(3): 196-204.
14. Nana P, Spanos K, Dakis K, et al. Factors associated with noninfectious fever after endovascular aortic aneurysm repair. J Endovasc Ther, 2022, 29(5): 739-745.
15. Gerasimidis T, Sfyroeras G, Trellopoulos G, et al. Impact of endograft material on the inflammatory response after elective endovascular abdominal aortic aneurysm repair. Angiol, 2005, 56(6): 743-753.
16. Koushki K, Shahbaz SK, Mashayekhi K, et al. Anti-inflammatory action of statins in cardiovascular disease: the role of inflammasome and toll-like receptor pathways. Clin Rev Allergy Immunol, 2021, 60(2): 175-199.
17. Greca E, Kacimi O, Poudel S, et al. Immunomodulatory effect of different statin regimens on regulatory T-cells in patients with acute coronary syndrome: A systematic review and network meta-analysis of randomized clinical trials. Eur Heart J Cardiovasc Pharmacother, 2023, 9(2): 122-128.
18. Satny M, Hubacek JA, Vrablik M. Statins and inflammation. Curr Atheroscler Rep, 2021, 23(12): 80.
19. Myasoedova E, Karmacharya P, Duarte-Garcia A, et al. Effect of statin use on the risk of rheumatoid arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum, 2020, 50(6): 1348-1356.
20. Pratesi C, Esposito D, Apostolou D, et al. Guidelines on the management of abdominal aortic aneurysms: Updates from the Italian Society of Vascular and Endovascular Surgery (SICVE). J Cardiovasc Surg (Torino), 2022, 63(3): 328-352.
21. 谢年谨, 罗淞元, 薛凌, 等. 预防性抗生素在导管室进行完全经皮穿刺主动脉覆膜支架植入术的应用. 南方医科大学学报, 2015, 35(4): 578-582.
22. Akin I, Nienaber CA, Kische S, et al. Effect of antibiotic treatment in patients with postimplantation syndrome after aortic stent placement. Rev Esp Cardiol, 2009, 62(12): 1365-1372.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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