The impact of obesity on perioperative and postoperative outcomes after elective endovascular abdominal aortic aneurysm repair

Abstract

Background Obesity is a common and growing health problem in vascular surgery patients, as it is in all patient groups. Evidence regarding body mass index (BMI) on endovascular aneurysm repair (EVAR) outcomes is not clear in the literature. We aimed to determine the impact of obesity on perioperative and midterm outcomes of elective EVAR between obese and non-obese patients. Methods Under a retrospective study design, a total of 120 patients (109 males, 11 females, mean age: 74.45 +/- 8.59 (53-92 years)) undergoing elective EVAR between June 2012 and May 2020 were reviewed. Patients were stratified into two groups: obese (defined as a body mass index (BMI) >= 30 kg/m(2)) and non-obese (mean BMI < 30 kg/m(2) (32.25 +/- 1.07 kg/m(2) vs 25.85 +/- 2.69 kg/m(2))). Results Of the 120 patients included in the study, 81 (67.5%) were defined as nonobese, while 39 (32.5%) were obese. The mean BMI of the study group was 27.93 +/- 3.78 kg/m(2). In obese patients, the procedure time, fluoroscopy time, and dose area product (DAP) values were longer than those of non-obese patients: 89.74 +/- 20.54 vs 79.69 +/- 28.77 min (p = 0.035), 33.23 +/- 10.14 vs 38.17 +/- 8.61 min (p = 0.01) and 133.69 +/- 58.17 vs 232.56 +/- 51.87 Gy.cm(2) (p < 0.001). Although there was no difference in sac shrinkage at 12-month follow-up, there was a significant decrease at 6-month follow-up in both groups (p = 0.017). Endoleak occurred in 17.9% (n = 7) of the obese group versus 11.1% (n = 9) of the non-obese group (p = 0.302). Iliac branch occlusion developed in four patients, 3 (3.7%) in the non-obese group and 1 (2.6%) in the obese group (p = 0.608). The all-cause mortality rate was slightly higher in the obese group; however, it did not differ between the groups (p = 0.463). Conclusion In addition to the longer procedure times, fluoroscopy times, and DAP values in obese patients, regardless of obesity, significant sac shrinkage in the first 6 months of follow-up was observed in both groups. No difference was documented with regards to mortality or morbidity following EVAR.