OBJECTIVETo determine the incidence, course, potential risk factors, and outcomes of noninfectious fever developed in patients after aortic surgery.

METHODSpatients who received operation for aortic aneurysm or dissection in our center from January 2006 to January 2008 were reviewed. Patients who met one of the following criteria were excluded: having a known source of infection during hospitalization; having a preoperative oral temperature greater than or equal to 38.0 degrees C; undertaking emergency surgery; having incomplete data. Univariate analysis was performed in patients with noninfectious postoperative fever and those without, with respect to demographics, intraoperative data, etc. Risk factors for postoperative fever were considered for the multivariate logistic regression model if they had a P value less than 0.10 in the univariate analysis.

RESULTSTotally 463 patients undergoing aortic surgery were enrolled for full review. Among them, 345 (74.5%) patients had noninfectious postoperative fever, the other 118 (25.5%) patients didn't develop postoperative fever. Univariate analysis demonstrated that several risk factors were associated with the development of noninfectious postoperative fever, including weight, surgical procedure, minimum intraoperative bladder temperature, temperature upon intensive care unit (ICU) admission, discharge, and during ICU stay, as well as blood transfusion. In a further multivariate analysis, surgical site of thoracic and thoracoabdominal aorta (odds ratio: 4.861; 95% confidence interval: 3.029-5.801; P=0.004), lower minimum intraoperative bladder temperature (odds ratio: 1.117; 95% confidence interval: 1.01-1.24; P=0.04), and higher temperature on admission to the ICU (odds ratio: 2.57; 95% confidence interval: 1.28-5.18; P=0.008) were found to be significant predictors for noninfectious postoperative fever. No difference was found between the febrile and afebrile patients with regard to postoperative hospitalization duration (P=0.558) or total medical costs (P=0.896).

CONCLUSIONNoninfectious postoperative fever following aortic surgery is very common and closely related with perioperative interventions.

Adult ; Aged ; Aneurysm, Dissecting ; surgery ; Aortic Aneurysm ; surgery ; Female ; Fever ; diagnosis ; epidemiology ; etiology ; Humans ; Incidence ; Interleukin-6 ; blood ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; etiology ; Risk Factors ; Transfusion Reaction

PURPOSE: To compare the outcomes of thoracic endovascular aortic repair (TEVAR) with those of open repair for descending thoracic aortic aneurysms (DTAA). MATERIALS AND METHODS: We compared the outcomes of 114 patients with DTAA and proximal landing zones 3 or 4 after TEVAR to those of 53 patients after conventional open repairs. Thirty-day and late mortality were the primary endpoints, and early morbidities, aneurysm-related death, and re-intervention were the secondary endpoints. RESULTS: The TEVAR group was older and had more incidences of dissecting aneurysm. The mean follow-up was 36+/-26 months (follow-up rate, 97.8%). The 30-day mortality in the TEVAR and open repair groups were 3.5% and 9.4% (p=0.11). Perioperative stroke and paraplegia incidences were similar between the groups [5.3% vs. 7.5% (p=0.56) and 7.5% vs. 3.5% (p=0.26), respectively]. Respiratory failure occurred more in the open repair group (1.8% vs. 26.4%, p<0.01). The incidence of acute kidney injury requiring dialysis was higher in the open repair group (1.8% vs. 9.4%, p<0.01). The cumulative survival rate was higher in the TEVAR group at 2 to 5 years (79.6% vs. 58.3%, p=0.03). The free from re-intervention was lower in the TEVAR group (65.3% vs. 100%, p=0.02), and the free from aneurysm-related death in the TEVAR and open repair groups were 88.5% and 86.1% (p=0.45). CONCLUSION: TEVAR is safe and effective for treating DTAAs with improved perioperative and long-term outcomes compared with open repair.
Age Factors ; Aged ; Aneurysm, Dissecting/*epidemiology/surgery ; Aortic Aneurysm, Thoracic/mortality/*surgery ; Aortic Rupture/mortality/*surgery ; Blood Vessel Prosthesis Implantation ; Endovascular Procedures ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Republic of Korea ; Stroke/etiology ; Survival Rate ; Time Factors ; Treatment Outcome

To observe the mid- and long-term result of intentional coverage of celiac artery in thoracic endovascular aortic repair (TEVAR) surgery for aortic dissection.
 Methods: We retrospectively analyzed 21 cases who received TEVAR with celiac artery coverage during the operation. The existence of collaterals between celiac artery (CA) and superior mesenteric artery (SMA) was confirmed by preoperative CT angiography (CTA) or digital substract angiography (DSA) for each patient. We used the stent-graft precisely above the orifice of SMA. Follow-ups were carried out at 2 weeks, 1 month, 3 months, 6 months, 1 year after the operation, and once per year thereafter.
 Results: No signs of visceral artery ischemic syptoms such as liver dysfunction, abdominal pain or distention were observed after the operation. There was no signs of spinal cord ischemia (SCI). Seven cases showed type II endoleak upon completion DSA but stopped automatically within 3 months. CTA in follow-ups showed thrombosis formation in false lumen.
 Conclusion: The intentional coverage of CA during the TEVAR for aortic dissection is safe and effective. The incidence of post-operative SCI or visceral artery ischemia is low. Type II endoleak is a major complication but it can be ceased automatically after medication.
Aneurysm, Dissecting ; surgery ; Angiography, Digital Subtraction ; Angioplasty ; methods ; Aorta, Thoracic ; surgery ; Aortic Aneurysm, Thoracic ; surgery ; Blood Vessel Prosthesis Implantation ; adverse effects ; methods ; Celiac Artery ; surgery ; Computed Tomography Angiography ; Endoleak ; etiology ; Endovascular Procedures ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Mesenteric Artery, Superior ; surgery ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Stents ; adverse effects ; Thrombosis ; etiology ; Treatment Outcome

PURPOSE: Acute aortic diseases, such as aortic dissection and aortic aneurysm, can be life-threatening vascular conditions. In this study, we compared outcomes before and after the implementation of a critical pathway (CP) for patients with acute aortic disease at the emergency department (ED). MATERIALS AND METHODS: This was a retrospective observational cohort study. The CP was composed of two phases: PRE-AORTA for early diagnosis and AORTA for prompt treatment. We compared patients who were diagnosed with acute aortic disease between pre-period (January 2010 to December 2011) and post-period (July 2012 to June 2014). RESULTS: Ninety-four and 104 patients were diagnosed with acute aortic disease in the pre- and post-periods, respectively. After the implementation of the CP, 38.7% of acute aortic disease cases were diagnosed via PRE-AORTA. The door-to-CT time was reduced more in PRE-AORTA-activated patients [71.0 (61.0, 115.0) min vs. 113.0 (56.0, 170.5) min; p=0.026]. During the post-period, more patients received emergency intervention than during the pre-period (22.3% vs. 36.5%; p=0.029). Time until emergency intervention was reduced in patients, who visited the ED directly, from 378.0 (302.0, 489.0) min in the pre-period to 200.0 (170.0, 299.0) min in the post-period (p=0.001). The number of patients who died in the ED declined from 11 to 4 from the pre-period to the post-period. Hospital mortality decreased from 26.6% to 14.4% in the post-period (p=0.033). CONCLUSION: After the implementation of a CP for patients with acute aortic disease, more patients received emergency intervention within a shorter time, resulting in improved hospital mortality.
Acute Disease ; Adult ; Aged ; Aneurysm, Dissecting/diagnosis/mortality/*surgery ; Aorta ; Aortic Aneurysm/diagnosis/mortality/*surgery ; Aortic Diseases/diagnosis/mortality/*surgery ; *Critical Pathways ; Emergency Service, Hospital/*organization & administration ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Outcome and Process Assessment (Health Care) ; Postoperative Complications/mortality ; Republic of Korea/epidemiology ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Vascular Surgical Procedures/*methods