Background
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.
Methods
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.
Results
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.
Conclusions
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.
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Article info
Publication history
Published online: February 28, 2023
Accepted:
February 21,
2023
Received:
December 6,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflict of interest: The authors have no competing interests.
Funding sources: No funding was provided.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
