title: Obesity as an independent predictor of outcome after endovascular abdominal aortic aneurysm repair.
abstract: BACKGROUND
  Obesity is increasingly common in patients referred for the management of an abdominal aortic aneurysm (AAA). Evidence of the effect of obesity on outcomes after endovascular repair (EVAR) is not well established. We sought to compare the immediate and midterm outcomes of elective EVAR between obese and nonobese patients in a case control study.
  
  
  METHODS
  Patients undergoing elective EVAR were divided in 2 groups: obese (defined as a body mass index [BMI] ≥30 kg/m(2)) and nonobese (mean BMI [kg/m(2)] ± SD: 33 ± 1 vs 25 ± 3). Both groups were case-matched for age, sex, smoking, and AAA diameter. One hundred fifty-nine patients were included (mean age: 69 ± 9 years; 10 women [9%]; mean BMI: 28 ± 5 kg/m(2); 53 were obese and 106 were nonobese). All aneurysms were successfully excluded. Mean follow-up was 34 ± 13 months.
  
  
  RESULTS
  All patients who developed a complication within the perioperative period (≤30 days) were obese (P = 0.01). Thirteen patients (8.2%) died during follow-up (8 obese versus 5 nonobese; P = 0.76). Survival and non-procedure-related morbidity did not differ significantly between the obese and nonobese groups (P = 0.64 and 0.16; log-rank test). BMI was not associated with mortality or non-procedure-related morbidity on multivariate analysis (mortality-hazard ratio: 1.0 [95% confidence interval: 0.9-1.2]; P = 0.37; non-procedure-related morbidity-hazard ratio: 1.0 [95% confidence interval: 0.9-1.1], P = 0.2).
  
  
  CONCLUSIONS
  This is the first case control study to assess the independent impact of obesity in the outcome after EVAR. No difference was documented with regards to mortality or non-aneurysm-related morbidity.
authors.affiliation: Warwickshire Vascular and Endovascular Unit, University Hospital Coventry and Warwickshire, Coventry, UK; Department of Vascular Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Research and Development, Dudley Group National Health Service Foundation Trust, Russells Hall Hospital, Dudley, UK. Electronic address: saratzis@doctors.net.uk.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Saratzis
authors.affiliation: Warwickshire Vascular and Endovascular Unit, University Hospital Coventry and Warwickshire, Coventry, UK; Division of Metabolic and Vascular Health, University of Warwick, Coventry, UK.
authors.forename: Mahmud
authors.initials: M
authors.lastname: Saedon
authors.affiliation: Department of Vascular Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Melas
authors.affiliation: Department of Research and Development, Dudley Group National Health Service Foundation Trust, Russells Hall Hospital, Dudley, UK.
authors.forename: George D
authors.initials: GD
authors.lastname: Kitas
authors.affiliation: Warwickshire Vascular and Endovascular Unit, University Hospital Coventry and Warwickshire, Coventry, UK.
authors.forename: Asif
authors.initials: A
authors.lastname: Mahmood
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D015992:Body Mass Index; D016022:Case-Control Studies; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome