C. W. Elliott1, J. Cullen2, J. Mehaffey2, W. Robinson2, K. J. Cherry2, M. C. Tracci2, G. R. Upchurch2 1University Of Virginia,School Of Medicine,Charlottesville, VIRGINIA, USA 2University Of Virginia,Department Of Surgery,Charlottesville, VIRGINIA, USA
Introduction:
With the increasing prevalence of obesity and atherosclerotic vascular disease, there is potential for an increasing incidence of overweight patients presenting with chronic mesenteric ischemia (CMI). The impact obesity plays on the clinical presentation and treatment of CMI is an understudied area of potential clinical importance. The purpose of this study was to evaluate if obesity impacts the diagnosis and treatment of CMI.
Methods:
Records of patients who received a procedure for CMI at a single center from 2007 to 2017 were obtained and reviewed. Patients were stratified into overweight (Body Mass Index [BMI] > 25) or non-overweight (BMI < 25). The primary outcome of interest was the number of preoperative diagnostic studies performed to make the diagnosis. Secondary endpoints included primary patency of the vascular reconstruction and 30-day mortality. Preoperative diagnostic studies included abdominal plain films, ultrasounds, cross-sectional imaging, endoscopy/colonoscopy, and angiogram.
Results:
A total of 90 patients were identified, and stratified into overweight (51.1%) and non-overweight. The number of preoperative diagnostic studies, a surrogate for delayed diagnosis, was significantly higher among the overweight (3.6 ± 1.9 vs. 2.7 ± 1.8, p = 0.04). These differences were driven by significantly more non-contrast CT scans (58.7% vs 25.0%, p=0.001) in the overweight group. However, overweight patients received fewer upper endoscopies (17.4 vs 36.4%, p=0.04). Endovascular interventions were the most common procedure to treat CMI, with 74% of overweight patients and 73% of non-overweight patients undergoing mesenteric vessel stenting (p = 0.9). There was no difference in the number of multi-vessel procedures performed in the overweight group (17.4% vs. 27.3% p=0.7). Thirty-day mortality (7.8% vs. 3.3%, p = 0.2) and time to loss of primary patency (19.25 ± 19.38 vs. 19.38 ± 18.36 months p = 0.8) did not differ between the groups.
Conclusion:
Overweight patients undergo an increased number of diagnostic tests prior to intervention to treat their CMI. An increase in the number of studies performed prior to CMI intervention in the overweight could be a proxy for a delay in time to diagnosis. Nevertheless, primary patency did not differ significantly between the two groups. As obesity continues to increase in prevalence, healthcare providers need to include CMI in their differential diagnosis for overweight patients.