Association Between Obesity and Outcomes Following Endovascular Aneurysm Repair

Area of Science:

• Vascular Surgery
• Cardiovascular Disease
• Obesity Medicine

Background:

• Obesity is common in patients with abdominal aortic aneurysms (AAA).
• Higher body mass index (BMI) correlates with increased cardiovascular mortality and morbidity.
• The impact of weight class on outcomes after EVAR for AAA requires further investigation.

Purpose of the Study:

• To compare mortality and complication rates in normal weight (NW), overweight (OW), and obese patients undergoing EVAR for infrarenal AAA.
• To assess the relationship between BMI and outcomes such as reintervention and aneurysm sac regression post-EVAR.
• To evaluate the safety and efficacy of EVAR across different weight categories.

Main Methods:

• Retrospective analysis of 515 patients undergoing EVAR for AAA (1998-2019).
• Patients categorized into underweight, NW (BMI 18.5-24.9 kg/m²), OW (BMI 25.0-29.9 kg/m²), obese (BMI 30.0-39.9 kg/m²), and morbidly obese (BMI >39.9 kg/m²).
• Primary outcomes: long-term all-cause mortality and freedom from reintervention. Secondary outcome: aneurysm sac regression. Kaplan-Meier and mixed model ANOVA used for analysis.

Main Results:

• Obese patients were younger and had higher rates of diabetes and dyslipidemia compared to NW patients.
• No significant differences in all-cause mortality (88% obese vs. 81% NW) or freedom from reintervention (79% obese vs. 79% NW) were observed.
• Aneurysm sac regression rates were similar across weight classes (49.6% NW, 50.6% OW, 51.8% obese) at mean follow-up of 5.1 years.

Conclusions:

• Obesity is not associated with increased long-term mortality or reintervention rates after EVAR for AAA.
• EVAR is a safe and effective treatment option for AAA regardless of patient weight category.
• Similar aneurysm sac regression rates suggest comparable treatment efficacy across weight classes.