Abdominal aortic aneurysm repair in obese patients: improved outcome after endovascular treatment compared with open surgery.

PURPOSE: To investigate outcomes in obese patients with abdominal aortic aneurysm (AAA) treated with elective open or endovascular repair (EVAR). STUDY DESIGN: We compared the outcomes of obese patients with AAA treated with elective open repair and EVAR. Obesity was defined as a body mass index (BMI) > or =30 kg/m( 2). RESULTS: A total of 56 patients with a BMI > or =30 kg/m(2) were identified for analysis (mean age 70 +/- 8 years; mean BMI 34 +/- 4 kg/m(2), and 95% [n = 53] were male). Open surgery was performed in 55% (n = 31). The in-hospital complication rate (including nonsurvivors) was significantly increased after open repair compared with EVAR (26% vs 4%, P = .033). Mortality did not differ significantly during 3 years of follow-up (P = .816). Length of stay, intensive care unit (ICU) stay, and need for ventilation were significantly increased after open surgery compared with EVAR. CONCLUSIONS: We observed improved short-term outcomes among obese AAA patients after EVAR compared to open repair. Endovascular repair may be preferable in obese patients with AAA.

Patients with abdominal aortic aneurysm and chronic obstructive pulmonary disease have improved outcomes with endovascular aneurysm repair compared with open repair.

The purpose of our study was to evaluate outcomes in abdominal aortic aneurysm (AAA) patients with chronic obstructive pulmonary disease (COPD) undergoing open or endovascular abdominal aortic aneurysm repair (EVAR). We retrospectively examined the records of consecutive patients with AAA and COPD who underwent either open repair or EVAR between 2001 and 2008. In-hospital and follow-up outcomes were compared between open repair and EVAR using SPSS (SPSS Inc, Chicago, IL). Sixty-nine patients were included for analysis (mean age 71 +/- 1.0 years; 93% [n = 64] male). Open surgery was performed in 63% (n = 43). In-hospital mortality was 4%. All-cause mortality did not differ significantly between the open repair and EVAR groups during 3 years of follow-up (p = .491). In-hospital death and major complications occurred in 30% (n = 13) after open repair compared with 12% (n = 3) after EVAR (p = .075). Pneumonia occurred in 19% (n = 8) after open repair and in 0% after EVAR (p = .019); pneumonia was associated with increased mortality during the first year after AAA repair (log-rank test p = .003). Hospital length of stay was increased in the open repair group compared with the EVAR group (16 vs 5 days, p < .001), as was intensive care unit length of stay (11 vs 2 days, p < .001) and need for ventilation (61% vs 12%, p < .001). Patients with COPD and anatomically suitable AAAs should be preferentially offered EVAR.

Influence of obesity on in-hospital and midterm outcomes after endovascular repair of abdominal aortic aneurysm.

PURPOSE: To evaluate the influence of obesity on outcomes after endovascular aneurysm repair (EVAR). METHODS: A retrospective analysis was conducted of 80 patients (77 men; mean age 75.0+/-7.6 years) undergoing elective EVAR for abdominal aortic aneurysm (AAA) between 2001 and 2008. Patients were stratified on presence of obesity [body mass index (BMI) >or=30 kg/m(2)). Outcomes in-hospital and during follow-up were compared between obese and non-obese patients. RESULTS: In this cohort, 26 (33%) patients had a BMI >or=30 kg/m(2). Mean BMI in the non-obese group was 25.6 kg/m(2) versus 34.1 kg/m(2) in the obese group (p<0.001). In obese patients, EVAR operating time was longer compared to non-obese patients: 217 versus 177 minutes (p = 0.006). One obese patient died after EVAR (p = 0.325); the combined operative mortality and major complication rate was 8% (n = 2) in the obese group versus 7% (n = 4) in the non-obese group (p = NS). Endoleak occurred in 25% (n = 6) of the obese group versus 14% (n = 7) of the non-obese group (p = 0.261). Postoperative intensive care for >24 hours (65% versus 70%, p = 0.796) and overall length of stay (3.9 versus 3.8 days, p = 0.845) did not differ significantly; neither did all-cause mortality during 2 years of follow-up (p = 0.688). CONCLUSION: Obesity is associated with extended operation times during EVAR, but increasing BMI appears to have little influence on outcomes after EVAR. A preferential approach to offering EVAR for obese patients may be reasonable.

Seconds from disaster: lessons learned from laparoscopic release of the median arcuate ligament.

Median arcuate ligament syndrome (MALS) is a rare entity that manifests as abdominal pain, nausea, vomiting, and diarrhea. The median arcuate ligament is a fibrous band that connects the crura of the diaphragm. In some people, the ligament is positioned in a way that compresses the celiac axis, which in a subset of individuals causes the symptoms associated with MALS. Surgical release of the ligament can relieve these symptoms. After viewing a video that described the laparoscopic median arcuate ligament release technique at the 2006 SAGES meeting and reviewing the online video, we report our experience with two cases and discuss the lessons learned in performing the procedure within a training program. We also discuss the extent to which surgical resident participation contributes to intraoperative complications during a new and complex surgery.