Endovascular Abdominal Aneurysm Repair is equally safe in obese and non-obese patients
Ming Kang, Rami Tadros, Chien Yi Png, Alex Sher, James Cornwall, Jennifer Grom, Melissa Tardiff, Ageliki G. Vouyouka, Rajiv Chander, Michael Marin, Peter Faries.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Objective
The goal of our study is to investigate the effects of obesity status on peri-operative and long term outcomes of patients who underwent endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA).
Methods
653 of 1529 consecutive patients who underwent AAA EVAR met our inclusion criteria and were reviewed. Patients were classified as obese (BMI > 30 kg/m(2)) and non-obese (BMI < 30 kg/m(2)). Preoperative demographic and comorbidity data were analyzed using T-tests and Chi-squared tests while peri-operative and long term outcomes were analyzed using Chi-squared tests.
Results
Of our 653 patients, 162 (24.81%) were obese (BMI > 30) and 491 (75.19%) were non-obese (BMI < 30). Obese patients are more likely to have diabetes (Obese: 38.27%, Non-obese: 19.56%, p<0.0001) and present for AAA repair at an earlier age (Obese: 72.25 ± 7.96, Non-obese: 75.49 ± 8.75, p= 0.012). While obese patients are younger at the time of EVAR, the AAA diameters at the time of repair were similar (Obese: 56.09 ± 9.28 mm, Non-Obese:56.67 ± 12.03 mm, p= 0.58). It was also found that, though the incidence of 30-day major peri-operative complication were not significant between obese and non-obese groups, the incidence of 30-day major access site infections (Obese: 0.62%, Non-Obese: 0%, p = 0.0818) and 30-day major lymphocele (Obese: 0.62%, Non-Obese: 0%, p = 0.0818) trend towards significance. Other peri-operative and long term outcomes were not significantly different between obese and non-obese patients. Specifically, length of stay, endoleak rates, AAA enlargement rates, need for reintervention, AAA related and overall mortality rates were similar despite obesity status.
Conclusion
While obese patients tend to present for AAA repair at an earlier age and are more likely to have diabetes, obesity is not independently associated with adverse peri-operative or long term outcome in AAA EVAR. Further investigation is required to determine whether obese patients are more at risk of various peri-operative complications.
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