Mansukhani Neel A, Hekman Katherine E, Yoon Dustin Y, Helenowski Irene B, Hoel Andrew W, Rodriguez Heron E, Pearce William H, Eskandari Mark K, Tomita Tadaki M
Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Ann Vasc Surg. 2018 Apr;48:159-165. doi: 10.1016/j.avsg.2017.09.026. Epub 2017 Dec 5.
Historically, patients with chronic mesenteric ischemia (CMI) are underweight with a low body mass index (BMI). However, with the recent obesity epidemic many of these patients now are overweight with a high BMI. We evaluated the impact of BMI on outcomes after mesenteric revascularization for CMI.
A retrospective chart review of patients undergoing open or endovascular mesenteric revascularization for CMI between January 2000 and June 2015 was performed. Demographics, comorbidities, BMI, Society for Vascular Surgery-combined comorbidity score, treatment modality, postoperative complications, reintervention, and all-cause mortality were analyzed. The primary end point for the study was all-cause mortality at 5 years. Patients were stratified using the World Health Organization BMI criteria. Univariate, Kaplan-Meier survival, and multivariate analyses were performed.
In the study period, 104 unique patients underwent mesenteric revascularization for CMI, for 77 of whom BMI information was available. Of these 77, 30 patients were treated by endovascular revascularization, and 47 patients were treated by open revascularization. Overall, 27 (35.1%) were overweight or obese with a BMI ≥25. Median follow-up time was 41 months. High BMI patients were less likely to have weight loss at the time of surgery (P = 0.004). Stratified by BMI <25 versus BMI ≥25, 5-year survival for patients treated by open revascularization was 90% versus 50% (P = 0.02); survival for patients treated by endovascular revascularization was 27% vs. 53% (P = 0.37). Multivariate survival analysis identified active smoking, hypertensive chronic kidney disease, open repair with the use of venous conduit instead of prosthetic conduit (P < 0.001), and history of peripheral arterial disease (PAD) (P = 0.002), as independent predictors of increased all-cause mortality.
BMI needs to be considered in assessing and counseling patients on outcomes of mesenteric revascularization for CMI, as a BMI over 25 is associated with poorer long-term survival after open revascularization. Smoking, hypertensive chronic kidney disease, PAD, and open repair with the use of venous conduit are independent predictors of long-term mortality after mesenteric revascularization independent of BMI.
从历史上看，慢性肠系膜缺血（CMI）患者体重不足，身体质量指数（BMI）较低。然而，随着近期肥胖症的流行，现在许多此类患者体重超重，BMI较高。我们评估了BMI对CMI肠系膜血管重建术后结局的影响。
对2000年1月至2015年6月期间接受开放性或血管内肠系膜血管重建术治疗CMI的患者进行回顾性病历审查。分析了人口统计学、合并症、BMI、血管外科学会合并症综合评分、治疗方式、术后并发症、再次干预和全因死亡率。该研究的主要终点是5年时的全因死亡率。使用世界卫生组织的BMI标准对患者进行分层。进行了单因素分析、Kaplan-Meier生存分析和多因素分析。
在研究期间，104例独特的患者接受了CMI肠系膜血管重建术，其中77例患者有BMI信息。在这77例患者中，30例接受了血管内血管重建术治疗，47例接受了开放性血管重建术治疗。总体而言，27例（35.1%）超重或肥胖，BMI≥25。中位随访时间为41个月。BMI较高的患者在手术时体重减轻的可能性较小（P = 0.004）。按BMI<25与BMI≥25分层，接受开放性血管重建术治疗的患者5年生存率分别为90%和50%（P = 0.02）；接受血管内血管重建术治疗的患者生存率分别为27%和53%（P = 0.37）。多因素生存分析确定，主动吸烟、高血压慢性肾病、使用静脉导管而非人工血管进行开放性修复（P < 0.001）以及外周动脉疾病（PAD）病史（P = 0.002）是全因死亡率增加的独立预测因素。
在评估和咨询CMI肠系膜血管重建术患者的结局时，需要考虑BMI，因为BMI超过25与开放性血管重建术后较差的长期生存率相关。吸烟、高血压慢性肾病、PAD以及使用静脉导管进行开放性修复是肠系膜血管重建术后长期死亡率的独立预测因素，与BMI无关。
