Hesham Alghofili, Daniyal N Mahmood, KongTeng Tan, Thomas F Lindsay
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引用次数: 0
Abstract
Background: Obesity represents a prevalent and escalating health concern among vascular surgery patients. Evidence pertaining to the influence of body mass index (BMI) on clinical outcomes after fenestrated-branched endovascular aneurysm repair (B/FEVAR) remains unclear. This study aims to assess the effect of obesity on short- and midterm clinical outcomes among individuals undergoing B/FEVAR.
Methods: This was a single-center retrospective analysis of all patients who underwent B/FEVAR from 2007 to 2020, with a median follow-up of 3.3 years (interquartile range, 1.6-5.3 years). Obesity was defined as a BMI of ≥30 kg/m2. Patients were divided into nonobese (NO) and obese cohorts according to their BMI. Outcomes were compared between the two groups subsequently.
Results: A total of 264 patients, 96 obese and 168 NO, were included. Patients with obesity were younger (72.8 ± 6.9 years vs 76.0 ± 7.3 years; P < .001), but had a higher prevalence of diabetes mellitus (27.1% vs 12.0%; P = .01) and dyslipidemia (80.2% vs 68.5%; P = .03). Both cohorts had similar rates of percutaneous access (37.5% for obese vs 35.1%; P = .7), and no significant differences in the rate of conversion to open access (8.3% for obese vs 4.2% for NO; P = .16). Technical success was similar between the cohorts (89% for obese vs 86%; P = .59). Major adverse events (MAEs) were higher in the NO group (13.1% vs 4.2%; P = .02). Patients in the obese cohort suffered more access site related infections (7.3% vs 1.2%; P = .01). All-cause mortality over 5 years was significantly higher in the NO group (35.1% vs 21.9%; P = .02). No statistical differences were found in spinal cord injury or dialysis requirement rates. Furthermore, on follow-up at 5 years, endoleak, branch instability, and reintervention rates were not statistically different between the two cohorts.
Conclusions: Patients with obesity are on average younger; however, they were more likely to suffer access site infections compared with NO patients. They had increased survival rates on follow-up, although rates of reinterventions and endoleaks were similar between the two cohorts. Our study demonstrates that, despite higher comorbidities, patients with obesity had similar intraoperative success with decreased postoperative mortality; however, access site infections remains a significant clinical concern.
背景：肥胖是血管外科患者普遍关注的健康问题，而且肥胖问题日益严重。有关体重指数（BMI）对血管内动脉瘤修补术（B/FEVAR）后临床结果的影响的证据仍不明确。本研究旨在评估肥胖对接受 B/FEVAR 术者短期和中期临床疗效的影响：这是一项单中心回顾性分析，研究对象是2007年至2020年期间接受B/FEVAR的所有患者，中位随访时间为3.3年[四分位距为1.6-5.3]。肥胖的定义是体重指数（BMI）≥30 kg/m2。根据体重指数将患者分为非肥胖组（NO）和肥胖组。随后对两组患者的治疗结果进行比较：结果：共纳入 264 名患者，其中肥胖患者 96 名，非肥胖患者 168 名。肥胖患者更年轻（72.8 ± 6.9 岁 vs 76 ± 7.3 岁，P< 0.001），但糖尿病（27.1% vs 12%，P= 0.01）和血脂异常（80.2% vs 68.5%，P=0.03）发病率更高。两组患者的经皮入路率相似（肥胖者为37.5% vs 35.1%，P=0.7），转为开放入路的比率无显著差异（肥胖者为8.3% vs 4.2%，P=0.16）。两组患者的技术成功率相似（肥胖者为 89% vs 86%，P=0.59）。NO组的主要不良事件（MAEs）较高（13.1% vs 4.2%，P= 0.02）。肥胖组患者的入路部位感染率更高（7.3% 对 1.2%，P= 0.01）。5年内全因死亡率，NO组明显更高（35.1% vs 21.9%，P= 0.02）。脊髓损伤或透析需求率没有统计学差异。此外，在5年的随访中，两组患者的内漏、分支不稳定和再介入率没有统计学差异：结论：肥胖患者平均年龄较小，但与非肥胖患者相比，他们更容易发生入路部位感染。结论：肥胖患者平均年龄较小，但与非肥胖患者相比，他们更容易发生入路部位感染，虽然两组患者的再介入率和内漏率相似，但他们的随访存活率更高。我们的研究表明，尽管肥胖患者的并发症较多，但他们的术中成功率相似，术后死亡率也较低，不过入路部位感染仍是一个重要的临床问题。
期刊介绍：
Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.
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