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

Corresponding?author：

MA Bingbing, Email: jsmabingbing@163.com

Keywords：

Aortic dilatation disease; 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 to explore management strategies. Methods A retrospective analysis was conducted on the clinical data of patients who underwent endovascular aortic repair for aortic dilatation diseases from January 2021 to October 2023. Based on inclusion and exclusion criteria, the enrolled patients were divided into a febrile group and an afebrile group according to the presence of postoperative fever. Clinical data, including demographics and surgical details, were compared between the two groups. Multivariate logistic regression analysis was performed on indicators with P≤0.05 in the univariate analysis, and receiver operating characteristic (ROC) curves were generated to analyze the predictive value of risk factors for postoperative noninfectious fever. Results A total of 305 patients were included in the final analysis. Postoperative noninfectious fever occurred in 75.08% (229/305) of the patients, with 98.25% of cases occurring within the first two postoperative days. The febrile group (n=229) had a median age of 65.0 (IQR: 53.0, 73.0) years with 83.4% males, while the afebrile group (n=76) had a median age of 71.0 (IQR: 65.0, 76.7) years with 84.2% males. Univariate analysis showed that the age, prevalence of coronary heart disease, preoperative statin use, and prevalence of aortic aneurysm were significantly lower in the febrile group compared to the afebrile group. Logistic regression analysis indicated that age, surgical site, disease type, preoperative elevated body temperature, and stent type were significantly associated with noninfectious fever, while preoperative statin use was negatively correlated. ROC curve analysis demonstrated that age, surgical site, preoperative elevated body temperature, and stent type had significant predictive value for postoperative noninfectious fever (P<0.01). Conclusion Noninfectious fever is highly prevalent following aortic repair. The relationship between fever and infection should be comprehensively evaluated based on risk factors and changes in the patient's condition to promote the rational use of antibiotics.

Citation： QIAN Zhengyue, FU Yao, ZHOU Wenbo, MA Bingbing. Clinical study on noninfectious fever of endovascular aortic repair. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(2): 275-280. doi: 10.7507/1007-4848.202402025 Copy

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.	中華醫學會心血管病學分會大血管學組, 中國醫師協會心血管內科醫師分會指南與共識工作委員會. 胸主動脈腔內治療圍手術期管理中國專家共識. 中華醫學雜志, 2019, 99(32): 2489-2496.Chinese Expert Consensus on Perioperative Management of Thoracic Aortic Endovascular Therapy by the Large Vessel Group of Chinese Society of Cardiology, Chinese Medical Association, and the Guidelines and Consensus Working Committee of Chinese College of Cardiovascular Physicians, Chinese Medical Doctor Association. Natl Med J China, 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, 2024, 149(3): 231-239.
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.	向軍, 何玲, 李東林, 等. 胸主動脈腔內修復術后全身炎癥反應綜合征的危險因素分析. 臨床心血管病雜志, 2021, 37(5): 468-472.Xiang J, He L, Li D, et al. Analysis of risk factors for systemic inflammatory response syndrome after thoracic endovascular aortic repair. J Clin Cardiol (China), 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.	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.
13.	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.
14.	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.
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.	謝年謹, 羅淞元, 薛凌, 等. 預防性抗生素在導管室進行完全經皮穿刺主動脈覆膜支架植入術的應用. 南方醫科大學學報, 2015, 35(4): 578-582.Xie N, Luo S, Xue L, et al. Application of prophylactic antibiotics in totally percutaneous aortic stent-graft implantation in catheterization laboratory. J South Med Univ, 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. 中華醫學會心血管病學分會大血管學組, 中國醫師協會心血管內科醫師分會指南與共識工作委員會. 胸主動脈腔內治療圍手術期管理中國專家共識. 中華醫學雜志, 2019, 99(32): 2489-2496.Chinese Expert Consensus on Perioperative Management of Thoracic Aortic Endovascular Therapy by the Large Vessel Group of Chinese Society of Cardiology, Chinese Medical Association, and the Guidelines and Consensus Working Committee of Chinese College of Cardiovascular Physicians, Chinese Medical Doctor Association. Natl Med J China, 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, 2024, 149(3): 231-239.
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. 向軍, 何玲, 李東林, 等. 胸主動脈腔內修復術后全身炎癥反應綜合征的危險因素分析. 臨床心血管病雜志, 2021, 37(5): 468-472.Xiang J, He L, Li D, et al. Analysis of risk factors for systemic inflammatory response syndrome after thoracic endovascular aortic repair. J Clin Cardiol (China), 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. 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.
13. 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.
14. 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.
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. 謝年謹, 羅淞元, 薛凌, 等. 預防性抗生素在導管室進行完全經皮穿刺主動脈覆膜支架植入術的應用. 南方醫科大學學報, 2015, 35(4): 578-582.Xie N, Luo S, Xue L, et al. Application of prophylactic antibiotics in totally percutaneous aortic stent-graft implantation in catheterization laboratory. J South Med Univ, 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

Clinical study on noninfectious fever of endovascular aortic repair

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