Obesity is prevalent in patients with abdominal aortic aneurysms (AAA). There is an association between increasing body mass index (BMI) and increased overall cardiovascular mortality and morbidity. This study aims to assess the difference in mortality and complication rates between normal weight (NW), overweight (OW), and obese patients undergoing endovascular aneurysm repair (EVAR) for infrarenal AAA.
This is a retrospective analysis of consecutive patients undergoing EVAR for AAA between January 1998 and December 2019. Weight classes were defined as: BMI<18.5 kg/m2, underweight; BMI 18.5–24.9 kg/m2, NW; BMI 25.0–29.9 kg/m2, OW; BMI 30.0–39.9 kg/m2, obese; BMI>39.9 kg/m2 morbidly obese. Primary outcomes were long-term all-cause mortality and freedom from reintervention. Secondary outcome was aneurysm sac regression (defined as a reduction in sac diameter of 5 mm or more). Kaplan-Meier survival estimates and mixed model analysis of variance were used.
The study included 515 patients (83% males, mean age 77 ± 8 years) with a mean follow-up of 3.8 ± 2.8 years. In terms of weight class, 2.1% (n = 11) were underweight, 32.4% (167) were NW, 41.6% (n = 214) were OW, 21.2% (n = 109) were obese, and 2.7% (n = 14) were morbidly obese. Obese patients were younger (mean difference −5.0 years) but had a higher prevalence of diabetes mellitus (33.3% vs. 10.6% for NW) and dyslipidemia (82.4% vs. 60.9% for NW). Obese patients had similar freedom from all-cause mortality (88%) compared to OW (78%) and NW (81%) patients. The same findings were evident for freedom from reintervention where obese (79%) was similar to OW (76%) and NW (79%). At a mean follow-up of 5.1 ± 0.4 years, sac regression was observed similarly across weight classes at 49.6%, 50.6%, and 51.8% for NW, OW, and obese, respectively (P = 0.501). There was a significant difference in mean AAA diameter pre- and post-EVAR [F(2,318) = 24.37, P < 0.001] across weight classes. NW [mean reduction 4.8 mm (2.0–7.6 mm, P < 0.001)], OW [mean reduction 3.9 mm (1.5–6.3 mm, P < 0.001)], and obese [mean reduction 5.7 mm (2.3–9.1 mm, P < 0.001)] achieved similar reductions.
Obesity was not associated with increased mortality or reintervention in patients undergoing EVAR. Obese patients achieved similar rates of sac regression on imaging follow-up.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Annals of Vascular Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The SuRF Report 2: surveillance of Chronic Disease Risk Factors: country-Level Data and Comparable Estimates.WHO, Geneva2005
- Obesity and the risk of Heart failure.N Engl J Med. 2002; 347: 305-313
- Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old.N Engl J Med. 2006; 355: 763-778
- Laparoscopic renal and adrenal surgery in obese patients: comparison to open surgery.J Urol. 1999; 162: 665-669
- Obesity in general elective surgery.Lancet. 2003; 361: 2032-2035
- Long-term results of endovascular abdominal aortic aneurysm treatment with the first generation of commercially available stent grafts.Arch Surg. 2007; 142: 33
- A comparison of administrative data and quality improvement registries for abdominal aortic aneurysm repair.J Vasc Surg. 2021; 73: 874-888
- The influence of polyvascular disease on the obesity paradox in vascular surgery patients.J Vasc Surg. 2011; 53: 399-406
- The effect of body mass index on major outcomes after vascular surgery.J Vasc Surg. 2017; 65: 1193-1207
- A systematic review and meta-analysis evaluating the impact of obesity on outcomes of abdominal aortic aneurysm treatment.J Vasc Surg. 2022; 75: 1450-1455.e3
- The impact of body mass index on perioperative and postoperative outcomes for endovascular abdominal aneurysm repair.Ann Vasc Surg. 2020; 62: 183-190.e1
- Obesity as an independent predictor of outcome after endovascular abdominal aortic aneurysm repair.Ann Vasc Surg. 2014; 28: 816-822
- Outcomes after elective abdominal aortic aneurysm repair in obese versus nonobese patients.J Vasc Surg. 2018; 68: 1696-1705
- Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults--the evidence report. National Institutes of Health.Obes Res. 1998; 6 Suppl 2: 51S-209S
- Life expectancy and causes of death after repair of intact and ruptured abdominal aortic aneurysms.J Vasc Surg. 2016; 63: 610-616
- The influence of body mass index obesity status on vascular surgery 30-day morbidity and mortality.J Vasc Surg. 2009; 49: 140-147.e1
- Mortality in open abdominal aortic surgery in patients with morbid obesity.Surg Obes Relat Dis. 2019; 15: 958-963
- EVAR trial investigators. Endovascular versus open repair of abdominal aortic aneurysm in 15-years’ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial.Lancet. 2016; 388: 2366-2374
- The impact of body mass index on perioperative outcomes of open and endovascular abdominal aortic aneurysm repair from the National Surgical Quality Improvement Program, 2005-2007.J Vasc Surg. 2010; 52: 1471-1477
- Open abdominal aortic aneurysm repair is associated with higher mortality among nonobese patients and higher risk of deep wound infections among obese patients.Ann Vasc Surg. 2020; 67: 354-369
- Impact of obesity on outcomes after open surgical and endovascular abdominal aortic aneurysm repair.J Am Coll Surg. 2010; 210: 166-177
- A systematic review and meta-analysis of the long-term outcomes of endovascular versus open repair of abdominal aortic aneurysm.J Vasc Surg. 2019; 70: 954-969.e30
- Aneurysm sac failure to regress after endovascular aneurysm repair is associated with lower long-term survival.J Vasc Surg. 2019; 69: 414-422
- Circulating markers of abdominal aortic aneurysm presence and progression.Circulation. 2008; 118: 2382-2392
- Obesity and inflammation: the linking mechanism and the complications.Arch Med Sci. 2017; 13: 851-863
Published online: February 28, 2023
Accepted: February 21, 2023
Received: December 6, 2022
Publication stageIn Press Journal Pre-Proof
Conflict of interest: The authors have no competing interests.
Funding sources: No funding was provided.
© 2023 Elsevier Inc. All rights reserved.