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Clinical Implications Of BMI On Patients Undergoing Open And Endovascular Femoropopliteal Interventions
Agastya Vaidya, BS
1, Neil Patel, BS, MBA
1, Rahman Sayed, BS
1, James Hu, MD
1, Jeffrey Indes, MD
2.
1Albert Einstein College of Medicine, Bronx, NY, USA,
2UMass Chan Medical School-Lahey, Burlington, MA, USA.
OBJECTIVES: Femoropopliteal open and endovascular interventions to treat peripheral vascular disease are currently performed in the setting of our society with an increasing average body mass index (BMI). Some studies suggest a paradoxical impact of BMI on post-operative outcomes for vascular disease. This study investigates the influence of BMI on post-operative outcomes in patients undergoing open and endovascular femoropopliteal interventions.
METHODS: Using a multi-institutional database, we retrospectively analyzed patients undergoing femoropopliteal interventions based on femoropopliteal bypass or endovascular treatment. Each group was further stratified by BMI: underweight (<18.5 kg/m
2), non-obese (18.5-29.9 kg/m
2), and obese (≥30 kg/m
2). Demographic data was collected for baseline characterization. Primary outcomes were: mortality at 30-days, 3-months, and 1-year, re-intervention at 30-days, 3-months, 6-months, and 1-year, and dehiscence rates within 1-week, 1-month, 3-months, and 1-year. Chi-square tests compared outcomes within BMI in each surgery type, and independent t-tests evaluated outcomes between the open and endovascular groups.
RESULTS: 16,132 patients underwent femoropopliteal interventions, with 5.4% underweight, 64.5% non-obese, and 30.1% obese in the open surgery group (8,133 patients) and 5.4% underweight, 65.3% non-obese, and 29.2% obese in the endovascular group (7,999 patients), with no significant difference in group sizes (p = 0.291). Hypertension, heart failure, atrial fibrillation/flutter, and diabetes were comorbidities observed across all BMI groups, with higher rates of diabetes and hypertension in obese patients of each surgery type. Underweight patients had higher mortality rates at all time points compared to other BMI groups in both open and endovascular interventions (all p-values < 0.011). Despite re-intervention rates not significantly differing within BMI groups for either surgery type, underweight patients had significantly higher re-intervention rates at 30-days and 3-months across both surgical types (p = 0.007 and p = 0.005, respectively). Wound dehiscence was not compared between the groups due to its low occurrence in endovascular procedures. No significant differences in mortality or re-intervention were found between open and endovascular procedures across all BMI groups and time points.
CONCLUSIONS: Underweight patients had higher mortality rates and reintervention rates than patients with higher BMI’s when undergoing both open and endovascular interventions for femoropopliteal occlusive disease. These findings underscore the importance of considering BMI-related risks in patients undergoing interventions for femoropopliteal peripheral artery disease.
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