NESVS1. Outcomes After Open and Endovascular Treatment of Infrainguinal Occlusive Disease in Morbidly Obese and Superobese Patients

Abstract

Although the effect of body mass index on the treatment of infrainguinal peripheral arterial disease (PAD) has been analyzed, outcomes of patients on the high end of the spectrum of morbid obesity (MO; body mass index >40) and superobesity (SO) are unclear. Our goal was to analyze perioperative outcomes of infrainguinal PAD after lower extremity bypass (LEB) and peripheral vascular interventions (PVIs) in this population of patients. The Vascular Quality Initiative was reviewed for all infrainguinal PAD interventions from 2010 to 2017. Patient and case details were recorded. Multivariable analysis was used to analyze outcomes. We identified 30,389 LEB cases (69.8% nonobese, 27.1% obese, 2.8% MO, 0.33% SO) and 84,649 PVI cases (67.9% nonobese, 28.1% obese, 3.5% MO, 0.52% SO). For LEB and PVI, MO and SO patients were younger, more often female, less often with smoking history, more often on Medicaid, and more often ambulatory, with diabetes, end-stage renal disease, congestive heart failure, and fewer previous inflow procedures (P < . 05 for all). LEB and PVIs in MO and SO were less often elective and more often for tissue loss. For LEB, MO and SO patients more often had great saphenous vein used as conduit and had popliteal artery origin grafts (P < .05). In PVI, MO and SO patients more often had tibial interventions (P < .05). Multivariable analysis showed that after LEB, MO and SO were not associated with increased perioperative cardiac complications, return to operating room, primary patency, and mortality. MO was associated with increased surgical site infection. Multivariable analysis showed that after PVI, MO and SO were not associated with periprocedural access site hematoma, access site stenosis or occlusion, and mortality. MO and SO were not independently associated with increased major adverse outcomes after LEB and PVI, aside from surgical site infections after LEB. Overall, MO and SO patients have more comorbidities and have more advanced presentation. MO and SO alone should not deter appropriate revascularization.