Impact of class of obesity on clinical outcomes following fenestrated-branched endovascular aneurysm repair

<h2>Abstract</h2><h3>Background</h3> Obesity represents a prevalent and escalating health concern among vascular surgery patients. Evidence pertaining to the influence of body mass index (BMI) on clinical outcomes after fenestrated-branched endovascular aneurysm repair (B/FEVAR) remains unclear. This study aims to assess the effect of obesity on short- and midterm clinical outcomes among individuals undergoing B/FEVAR. <h3>Methods</h3> This was a single-center retrospective analysis of all patients who underwent B/FEVAR from 2007 to 2020, with a median follow-up of 3.3 years (interquartile range, 1.6-5.3 years). Obesity was defined as a BMI of ≥30 kg/m². Patients were divided into nonobese (NO) and obese cohorts according to their BMI. Outcomes were compared between the two groups subsequently. <h3>Results</h3> A total of 264 patients, 96 obese and 168 NO, were included. Patients with obesity were younger (72.8 ± 6.9 years vs 76.0 ± 7.3 years; <i>P</i> < .001), but had a higher prevalence of diabetes mellitus (27.1% vs 12.0%; <i>P</i> = .01) and dyslipidemia (80.2% vs 68.5%; <i>P</i> = .03). Both cohorts had similar rates of percutaneous access (37.5% for obese vs 35.1%; <i>P</i> = .7), and no significant differences in the rate of conversion to open access (8.3% for obese vs 4.2% for NO; <i>P</i> = .16). Technical success was similar between the cohorts (89% for obese vs 86%; <i>P</i> = .59). Major adverse events (MAEs) were higher in the NO group (13.1% vs 4.2%; <i>P</i> = .02). Patients in the obese cohort suffered more access site related infections (7.3% vs 1.2%; <i>P</i> = .01). All-cause mortality over 5 years was significantly higher in the NO group (35.1% vs 21.9%; <i>P</i> = .02). No statistical differences were found in spinal cord injury or dialysis requirement rates. Furthermore, on follow-up at 5 years, endoleak, branch instability, and reintervention rates were not statistically different between the two cohorts. <h3>Conclusions</h3> Patients with obesity are on average younger; however, they were more likely to suffer access site infections compared with NO patients. They had increased survival rates on follow-up, although rates of reinterventions and endoleaks were similar between the two cohorts. Our study demonstrates that, despite higher comorbidities, patients with obesity had similar intraoperative success with decreased postoperative mortality; however, access site infections remains a significant clinical concern.