Abdominal Aortic Aneurysm Repair in Obese Patients: Improved Outcome After Endovascular Treatment Compared With Open Surgery

Abstract

Purpose: To investigate outcomes in obese patients with abdominal aortic aneurysm (AAA) treated with elective open or endovascular repair (EVAR).

Study Design: We compared the outcomes of obese patients with AAA treated with elective open repair and EVAR. Obesity was defined as a body mass index (BMI) ≥30 kg/m².

Results: A total of 56 patients with a BMI ≥30 kg/m² were identified for analysis (mean age 70 ± 8 years; mean BMI 34 ± 4 kg/m², and 95% [n = 53] were male). Open surgery was performed in 55% (n = 31). The in-hospital complication rate (including nonsurvivors) was significantly increased after open repair compared with EVAR (26% vs 4%, P = .033). Mortality did not differ significantly during 3 years of follow-up (P = .816). Length of stay, intensive care unit (ICU) stay, and need for ventilation were significantly increased after open surgery compared with EVAR.

Conclusions: We observed improved short-term outcomes among obese AAA patients after EVAR compared to open repair. Endovascular repair may be preferable in obese patients with AAA.

Keywords

abdominal aortic aneurysm obesity open surgery endovascular repair outcomes

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References

Mokdad AH , Marks JS , Stroup DF , Gerberding JL Actual causes of death in the United States, 2000. JAMA. 2004;291(10): 1238-1245.

Mokdad AH , Marks JS , Stroup DF , Gerberding JL Correction: actual causes of death in the United States, 2000. JAMA. 2005; 293(3):293-294.

Wang Y. , Beydoun MA The obesity epidemic in the United States-gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis . Epidemiol Rev. 2007;29:6-28.

Wang Y. , Beydoun MA , Liang L. , Caballero B. , Kumanyika SK Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic. Obesity (Silver Spring) . 2008;16(10):2323-2330.

Adams KF , Schatzkin A. , Harris TB , et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006;355(8):763-778.

Renehan AG , Tyson M. , Egger M. , Heller RF , Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008; 371(9612):569-578.

Hubert HB , Feinleib M. , McNamara PM , Castelli WP Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation. 1983;67(5):968-977.

Kenchaiah S. , Evans JC , Levy D. , et al. Obesity and the risk of heart failure . N Engl J Med. 2002;347(5):305-313.

Yusuf S. , Hawken S. , Ounpuu S. , et al. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet. 2005;366(9497):1640-1649.

10.

Cassidy AE , Bielak LF , Zhou Y. , et al. Progression of subclinical coronary atherosclerosis: does obesity make a difference? Circulation. 2005;111(15):1877-1882.

11.

Hoefle G. , Saely CH , Aczel S. , et al. Impact of total and central obesity on vascular mortality in patients undergoing coronary angiography. Int J Obes (Lond) . 2005;29(7):785-791.

12.

Planas A. , Clara A. , Pou JM , et al. Relationship of obesity distribution and peripheral arterial occlusive disease in elderly men. Int J Obes Relat Metab Disord . 2001;25(7):1068-1070.

13.

Golledge J. , Clancy P. , Jamrozik K. , Norman PE Obesity, adipokines, and abdominal aortic aneurysm: health in men study. Circulation. 2007;116(20):2275-2279.

14.

Khandanpour N. , Armon MP , Foxall R. , Meyer FJ The effects of increasing obesity on outcomes of vascular surgery. Ann Vasc Surg. 2008;23(3):310-316.

15.

Shenkman Z. , Shir Y. , Brodsky JB Perioperative management of the obese patient . Br J Anaesth. 1993;70(3):349-359.

16.

Pelosi P. , Croci M. , Ravagnan I. , et al. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg. 1998;87(3): 654-660.

17.

Hans GA , Pregaldien AA , Kaba A. , et al. Pressure-controlled ventilation does not improve gas exchange in morbidly obese patients undergoing abdominal surgery. Obes Surg. 2008; 18(1):71-76.

18.

Strandberg A. , Tokics L. , Brismar B. , Lundquist H. , Hedenstierna G. Constitutional factors promoting development of atelectasis during anaesthesia. Acta Anaesthesiol Scand . 1987;31(1):21-24.

19.

Bamgbade OA , Rutter TW , Nafiu OO , Dorje P. Postoperative complications in obese and nonobese patients. World J Surg. 2007;31(3):556-560.

20.

Davenport DL , Xenos ES , Hosokawa P. , Radford J. , Henderson WG , Endean ED The influence of body mass index obesity status on vascular surgery 30-day morbidity and mortality. J Vasc Surg. 2009;49(1):140-147, 147.e1.

21.

Prinssen M. , Verhoeven EL , Buth J. , et al, for the Dutch Randomized Endovascular Aneurysm Management (DREAM) Trial Group. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351(16):1607-1618.

22.

Greenhalgh RM , Brown LC , Kwong GP , Powell JT , Thompson SG Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet. 2004;364(9437):843-848.

23.

Schermerhorn ML , O’Malley AJ , Jhaveri A. , Cotterill P. , Pomposelli F. , Landon BE Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med. 2008;358(5):464-474.

24.

Fleischmann E. , Kurz A. , Niedermayr M. , et al. Tissue oxygenation in obese and non-obese patients during laparoscopy. Obes Surg. 2005 ;15(6):813-819.