肥胖与胸主动脉和开窗分支血管腔内修复术的围手术期不良事件或较差的临床结局无关。
Obesity is Not Associated with Adverse Perioperative or Poorer Clinical Outcomes following Thoracic and Fenestrated-Branched Endovascular Aortic Repair.
机构信息
CHU Nantes, L'institut du Thorax, Service de chirurgie cardiaque et vasculaire, Nantes, France.
CHU Nantes, L'institut du Thorax, Service de chirurgie cardiaque et vasculaire, Nantes, France; Université de Nantes, Nantes, France.
出版信息
Ann Vasc Surg. 2023 Sep;95:42-49. doi: 10.1016/j.avsg.2023.04.002. Epub 2023 Apr 15.
BACKGROUND
Obesity is a risk factor for higher morbidity and mortality following open aortic repair but currently there is limited literature on its impact on clinical and procedural outcomes following thoracic endovascular aortic repair (TEVAR) and branched-fenestrated endovascular aortic repair (B-FEVAR).
METHODS
We conducted a retrospective case-control analysis of a prospectively collected nonrandomized database to evaluate the effects of obesity on procedural and clinical outcomes after B-FEVAR/TEVAR in treatment of pararenal/thoracoabdominal aortic aneurysm and dissection at the University hospital of Nantes (France) between January 2016 and December 2021. Patients were divided in 2 groups according to their body mass index (BMI) and the rate of technical success, complications (renal, pulmonary, cardiac, and neurological events), 30-day and long-term survival, freedom from target vessel instability and reintervention were compared.
RESULTS
195 patients were included (mean age 69.6 DS±11.2; n = 135, 69.2% men; mean BMI: 26.6 kg/m2 range 19-41) totalling n = 72 (36.8%) TEVAR, n = 107 (55.4%) FEVAR and n = 14 (7.3%) BEVAR. Patients were divided in 2 groups [obese: BMI≥30 kg/mn = 52 (26.7%); and nonobese, BMI<30 kg/m, n = 143 (73.3%) that statistically differed only in terms of coronary artery disease (obese 42.3% vs. 26.6% nonobese, P = 0.035) and diabetes (obese 25% vs. 12.6% nonobese, P = 0.03). No statistical differences were noted in primary technical (94.2% vs. 94.4%, P = 1.00) and clinical (92.3% vs. 95.1%, P = 0.49) success. Overall morbidity (30.8% vs. 21.1%, P = 0.16), visceral vessels instability (1.9% vs. 1.4% P = 1.00), reintervention rate within 30 days (9.6% vs. 5.6% P = 0.33), 90 days (7.7% vs. 9.8%, P = 0.78) and during follow-up (9.8% vs. 20%, P = 0.14) were comparable. No statistical difference were noted in 30-day mortality (3.8% vs. 4.9%, P = 1.00) and the 2-year follow-up survival (86.8% vs. 78.4%, P = 0.180) between the 2 groups.
CONCLUSIONS
In this series, obesity was not associated to worst clinical outcomes or higher mortality rate following TEVAR/B-FEVAR. However, considering our small patient sample, a conclusive analysis on obesity as risk factors for adverse events after endovascular treatment is not possible. A larger sample from the collaboration of multiple centers will be required to obtain definitive conclusions.
背景
肥胖是开放式主动脉修复术后发病率和死亡率升高的一个风险因素，但目前关于其对胸主动脉腔内修复术（TEVAR）和分支型开窗/分支型腔内修复术（B-FEVAR）后临床和程序结果的影响的文献有限。
方法
我们对一个前瞻性收集的非随机数据库进行了回顾性病例对照分析，以评估肥胖对法国南特大学医院 2016 年 1 月至 2021 年 12 月期间治疗肾/胸腹主动脉瘤和夹层的 B-FEVAR/TEVAR 后程序和临床结果的影响。根据患者的体重指数（BMI）将患者分为两组，比较两组技术成功率、并发症（肾、肺、心脏和神经事件）、30 天和长期存活率、靶血管稳定性和再介入的无复发率。
结果
共纳入 195 例患者（平均年龄 69.6 ± 11.2 岁；n = 135，69.2%为男性；平均 BMI：26.6 kg/m2，范围 19-41），其中 72 例（36.8%）接受了 TEVAR，107 例（55.4%）接受了 FEVAR，14 例（7.3%）接受了 BEVAR。患者分为两组[肥胖组：BMI≥30 kg/mn = 52 例（26.7%）；非肥胖组，BMI<30 kg/m，n = 143 例（73.3%），仅在冠状动脉疾病（肥胖组 42.3%，非肥胖组 26.6%，P = 0.035）和糖尿病（肥胖组 25%，非肥胖组 12.6%，P = 0.03）方面存在统计学差异。主要技术（94.2% vs. 94.4%，P = 1.00）和临床（92.3% vs. 95.1%，P = 0.49）成功率无统计学差异。总体发病率（30.8% vs. 21.1%，P = 0.16）、内脏血管不稳定（1.9% vs. 1.4%，P = 1.00）、30 天内再介入率（9.6% vs. 5.6%，P = 0.33）、90 天（7.7% vs. 9.8%，P = 0.78）和随访期间（9.8% vs. 20%，P = 0.14）相似。两组 30 天死亡率（3.8% vs. 4.9%，P = 1.00）和 2 年随访存活率（86.8% vs. 78.4%，P = 0.18）无统计学差异。
结论
在本系列中，肥胖与 TEVAR/B-FEVAR 后较差的临床结局或更高的死亡率无关。然而，考虑到我们的小患者样本，关于肥胖作为血管内治疗后不良事件的风险因素的结论性分析是不可能的。需要来自多个中心的合作的更大样本量才能得出明确的结论。
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