Obesity and vascular surgery

Abstract

BackgroundEvery second German is overweight, and German residents are among those with the highest body mass index (BMI) in Europe. Therefore, obesity is an everyday problem in vascular surgery. In venous diseases, weight has a direct influence on the disease’s progress. With increasing BMI, the clinical signs of chronic venous disease increase, up to ulceration. The therapeutic results of arterial diseases are also influenced. In this article, the role of obesity in the treatment of vascular patients is discussed.ResultsVaricose vein surgery: Sixty-five percent of patients undergoing varicose vein surgery are overweight, obese, or extremely obese. Because of demanding preparation in the groin and, frequently, large side branches, the duration of surgery is extended, but complications are rare. Surgical site infections (SSIs) are equal in all weight classes. A causal relationship between body weight and recurrent varicose veins is not evident. The success of endovenous laser treatment does not depend on weight.Arterial surgery: Both with open and endovascular procedures, the operating time is extended in obese patients, but there is no increase in complications, with the exception of SSIs. The technical results (patency rates) of the different procedures are not influenced. According to the 30-day mortality rate, underweight or severely overweight patients are disadvantaged.ConclusionVascular surgery on obese patients demands good surgical practice and takes extra time. Increased SSIs and 30-day mortality are observed with arterial procedures. Neither venous nor arterial surgery is influenced by weight, according to the direct results.