Pleural Effusion after Endovascular Grafting for Aortic Dissection

Yoshiko Watanabe Shin Ishimaru Satoshi Kawaguchi
Taro Shimazaki

(Department of Surgery II, Tokyo Medical University, Tokyo, Japan)

We studied the appearance of pleural effusion and inflammatory reactions after endovascular grafting in cases of aortic dissection. From December 1995 to January 2000, 16 patients with chronic double-barrel type aortic dissection (DeBakey type Vb) were treated by endovascular grafting. In all cases, enhanced computed tomography (CT) of the chest was examined before operation and at about the 7th postoperative day (POD). Patients were divided into 3 groups. Group P: patients who had pleural effusion before the operation. Group E: patients who had new pleural effusion after the operation. Group N: patients who did not have any pleural effusion. In each group, onset of dissection, patient's age, maximum diameter of dissecting aorta, period of postoperative fever (above 37.0), and WBC counts and CRP value at POD 1, 3, 7 and 14 were compared. Four patients were in group P, 4 patients were in group E, and 8 patients were in group N. Period between onset and operation was 41.6}34.6months in group P, 18.2}27.3months in group E and 7.3}11.6months in group N. There was no relation between the effusion and the period after onset. Postoperative fever continued for 5.0}2.0 days in group P, 13.5}2.6 days in group E and 2.5}0.3 days in group N. The period of fever of group E was significantly longer than in group N and P (p<0.01). WBC showed a peak on the first POD in each group. CRP showed a peak value on POD 3 in group P and N. There was no significance among the 3 groups about WBC and CRP, but group E showed slightly high CRP values on POD 7 and 14. No patient had complications regarding respiratory function. After endovascular grafting for aortic dissection, postoperative pleural effusion appeared in 25% of patients. They had prolonged postoperative fever, but there was no respiratory function complication. Endovascular grafting is a minimally invasive procedure with regard to respiratory function.
@Jpn. J. Cardiovasc. Surg. 31F3-7i2002)