Interdisciplinary German clinical practice guidelines on the management of type B aortic dissection

Oberhuber, Alexander; Raddatz, Alexander; Betge, Stefan; Ploenes, Christoph; Ito, Wulf; Janosi, Rolf-Alexander; Ott, Christian; Langheim, Eike; Czerny, Martin; Puls, Ralf; Maßmann, Alexander; Zeyer, Karina A.; Schelzig, Hubert

doi:10.1007/s00772-023-00995-5

Cited by 8 publications

(3 citation statements)

References 253 publications

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“…The definition of PIS is variable in the current literature and the variability of the different incidences is due to the different definitions and diagnostic criteria in each study [5,6,7]. In our cohort, the occurrence of PIS was defined by the presence of fever (> 38°C lasting longer than 24 hours) and leucocytosis (WBCC > 12000/μL) [4]. However, it is known that other markers, such as C-reactive protein (CRP), are known to be related to the occurrence of PIS.…”

Section: Discussionmentioning

confidence: 99%

“…The development of thoracic endovascular aortic repair (TEVAR) has allowed a minimally invasive approach for type B aortic dissections (TBADs) in different settings (acute complicated and acute uncomplicated dissections and chronic thoracic enlargements). Endovascular therapy should be used in patients with complicated acute TBADs and with chronic aortic dissections in cases of malperfusion, aortic rupture, or progression of the dissection [1,2,3,4].…”

Section: Introductionmentioning

confidence: 99%

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Fever Management after TEVAR in Patients with Aortic Dissection

et al. 2022

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Background Post-implantation syndrome (PIS) is characterised as a noninfectious continuous fever and a concomitant rise in inflammatory markers shortly after thoracic endovascular aortic repair (TEVAR). This current study aims to analyse the risk factors of PIS, postoperative major adverse cardiac events (MACE), and overall survival as well as the correlation between new-onset mural thrombus and the risk of developing PIS after TEVAR in patients with type B aortic dissection (TBAD). Patients were included who had a B dissection, both acute and chronic forms. In the acute form, both acutely complicated and uncomplicated patients were included in the study. A main point of our investigation is the postoperative fever management of PIS patients. Methods A total of 90 patients with type B dissection underwent TEVAR in the University Hospital of Muenster between 2016 and 2020. The occurrence of PIS was defined as the presence of fever (> 38°C lasting longer than 24 hours in hospital) and leucocytosis (white blood cell count > 12000/µL). Patients with other possible reasons for fever and/or leucocytosis, such as a urinary tract infection (UTI), pneumonia, or sepsis, were excluded beforehand. Besides demographic and operation-related data, inflammatory markers and therapeutic measures were evaluated before and 5 days postoperatively. Computed tomography scans were examined to calculate the volume of preexistent and new-onset mural thrombus after TEVAR. Results Of 90 patients, 40 patients were excluded because of recent infection or bypass surgery. Of the 50 patients included in the study, 10 patients developed post-implantation syndrome. Younger patients significantly more often developed PIS after TEVAR (52.2 ± 11.6 vs. 61.5 ± 13.6, p = 0.045). New-onset thrombus after TEVAR was significantly higher in PIS patients (61 cm³ vs. 12 cm³, p < 0.001) and PIS patients often received more medical examinations (investigation of X-ray, U status, and blood cultures). There was no significant difference in overall survival for 40 months and in the incidence of MACE. Conclusions PIS may be related to an increased rate of new-onset thrombus. A more robust conclusion is not justified according to our study. There is no difference in overall survival.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fever Management after TEVAR in Patients with Aortic Dissection

et al. 2022

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“…Patients with AAD frequently present with tearing chest pain that radiates to the back. It remains a significant health care burden with a gender-adjusted incidence of 2.53/100,000 [1] for Stanford type B aortic dissections and up to 15/1000,000 for overall AAD [2]. The health care costs of these events are substantial and often generate additional costs over subsequent years [3].…”

Section: Introductionmentioning

confidence: 99%

Ethanol Enhances Endothelial Rigidity by Targeting VE-Cadherin—Implications for Acute Aortic Dissection

Mulorz

Ibing

Cappallo

et al. 2023

JCM

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(1) Background: Acute aortic dissection (AAD) is caused by an endothelial entry tear followed by intimomedial delamination of the outer layers of the vessel wall. The established risk factors include hypertension and smoking. Another rising candidate risk factor is excessive alcohol consumption. This experimental study explores the effects of nicotine (Nic), angiotensin II (Ang II), and ethanol (EtOH) on human aortic endothelial cells (hAoEC). (2) Methods: HAoECs were exposed to Nic, Ang II, and EtOH at different dose levels. Cell migration was studied using the scratch assay and live-cell imaging. The metabolic viability and permeability capacity was investigated using the water-soluble tetrazolium (WST)-1 assay and an in vitro vascular permeability assay. Cell adherence was studied by utilizing the hanging drop assay. The transcriptional and protein level changes were analyzed by RT-qPCR, Western blotting and immunohistochemistry for major junctional complexing proteins. (3) Results: We observed reduced metabolic viability following Ang II and EtOH exposure vs. control. Further, cell adherence was enhanced by EtOH exposure prior to trituration and by all risk factors after trituration, which correlated with the increased gene and protein expression of VE-cadherin upon EtOH exposure. The cell migration capacity was reduced upon EtOH exposure vs. controls. (4) Conclusion: Marked functional changes were observed upon exposure to established and potential risk factors for AAD development in hAoECs. Our findings advocate for an enhanced mechanical rigidity in hAoECs in response to the three substances studied, which in turn might increase endothelial rigidity, suggesting a novel mechanism for developing an endothelial entry tear due to reduced deformability in response to increased shear and pulsatile stress.

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