T. R. Foster1,2, G. Kuwahara2, K. Yamamoto2, R. Assi1,2, C. D. Protack1,2, M. R. Hall1,2, W. Williams1,2, P. Vasilas1, A. Dardik1,2 1VA Connecticut Healthcare System,West Haven, CT, USA 2Yale University School Of Medicine,New Haven, CT, USA
Introduction:
Metabolic syndrome increases the risk of cardiovascular events in patients with peripheral vascular disease. However, the role of metabolic syndrome in predisposing towards postoperative complications after vascular surgery is poorly described. This study explores the effect of metabolic syndrome on adverse events after four commonly performed vascular surgical operations.
Methods:
The records of patients who underwent carotid endarterectomy (CEA), arteriovenous fistula creation (AVF), major lower extremity amputation, or endovascular abdominal aortic aneurysm repair (EVAR) from 2004-2008 at a single institution were reviewed. An adverse event was defined according to operation and includes: re-stenosis > 50% after CEA, AVF primary failure < 6 mo, non-healing of the amputation site requiring operative revision, or development of endoleak any time after EVAR. These events were combined to study the effect of metabolic syndrome on the rate of overall post surgical adverse events. Metabolic syndrome (MetS) was defined as three or more of the following: blood pressure ≥ 130/85 or on antihypertensive medication, serum triglycerides ≥ 150 mg/dl, HDL ≤ 40 mg/dl for men or ≤ 50 mg/dl for women, fasting blood glucose ≥ 110 mg/dl or on anti-hyperglycemic medication, or BMI ≥ 27 kg/m2.
Results:
A total of 274 patients were included in the study. 99% of the patients were male. The average age was 69 years, 76% were Caucasian. Mean follow up was 3.6 years. 69% of the patients had MetS and were more likely to be Caucasian. The baseline demographics were otherwise similar except that patients with MetS had statistically significant differences, compared to patients without MetS, in mean triglyceride level of 180 vs 119 (p<0.0001), mean HDL level of 35 vs 50 (p<0.0001), hypertension was present in 98% vs 86% of patients (p<0.0001), diabetes present in 68% vs 18% (p<0.0001), and BMI > 27 in 76% vs 21% of patients (p<0.0001). Patients with MetS had an increased rate of adverse events, 44% versus 33% (p=0.07, Chi-Square). Of all factors examined, logistic regression showed MetS to be the most predictive independent factor for adverse events (OR 2.89, p = 0.0020) There was no statistical significance in overall survival between patients with and without MetS (p = 0.66 Log-rank).
Conclusion:
Metabolic syndrome is prevalent among patients undergoing vascular surgical operations. MetS is an independent risk factor for adverse events following these operations, suggesting that MetS is a factor identifying high risk patients after vascular surgery. Patients with MetS may require increased post operative surveillance or targeted treatment to reduce the rate of these events.