Impact of Body Mass Index on Outcomes after Mesenteric Revascularization for Chronic Mesenteric Ischemia
Open accessAbstract
Background Historically, patients with chronic mesenteric ischemia (CMI) are underweight with a low body mass index (BMI). However, with the recent obesity epidemic many of these patients now are overweight with a high BMI. We evaluated the impact of BMI on outcomes after mesenteric revascularization for CMI.Methods A retrospective chart review of patients undergoing open or endovascular mesenteric revascularization for CMI between January 2000 and June 2015 was performed. Demographics, comorbidities, BMI, Society for Vascular Surgery-combined comorbidity score, treatment modality, postoperative complications, reintervention, and all-cause mortality were analyzed. The primary end point for the study was all-cause mortality at 5 years. Patients were stratified using the World Health Organization BMI criteria. Univariate, Kaplan-Meier survival, and multivariate analyses were performed.Results In the study period, 104 unique patients underwent mesenteric revascularization for CMI, for 77 of whom BMI information was available. Of these 77, 30 patients were treated by endovascular revascularization, and 47 patients were treated by open revascularization. Overall, 27 (35.1%) were overweight or obese with a BMI ≥25. Median follow-up time was 41 months. High BMI patients were less likely to have weight loss at the time of surgery (P = 0.004). Stratified by BMI <25 versus BMI ≥25, 5-year survival for patients treated by open revascularization was 90% versus 50% (P = 0.02); survival for patients treated by endovascular revascularization was 27% vs. 53% (P = 0.37). Multivariate survival analysis identified active smoking, hypertensive chronic kidney disease, open repair with the use of venous conduit instead of prosthetic conduit (P < 0.001), and history of peripheral arterial disease (PAD) (P = 0.002), as independent predictors of increased all-cause mortality.Conclusions BMI needs to be considered in assessing and counseling patients on outcomes of mesenteric revascularization for CMI, as a BMI over 25 is associated with poorer long-term survival after open revascularization. Smoking, hypertensive chronic kidney disease, PAD, and open repair with the use of venous conduit are independent predictors of long-term mortality after mesenteric revascularization independent of BMI.
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Prognostic factors associated with bad long-term outcome after open mesenteric revascularization include body mass index > 25 kg/m, smoking, peripheral artery disease, hypertensive chronic kidney disease, and open mesenteric bypass with a venous graft.
“These include body mass index > 25 kg/m, smoking, peripheral artery disease, hypertensive chronic kidney disease, and open mesenteric bypass with a venous graft[130].”
From Ischemic bowel disease in 2021. (2021) · cites this paper as [130]
The Conclusions report poorer long-term survival with BMI ≥25 after open revascularization and identify smoking, hypertensive chronic kidney disease, peripheral arterial disease, and use of a venous conduit as predictors of mortality. However, the other predictors were identified in the combined mesenteric-revascularization cohort, not specifically among patients who underwent open surgery (Results, §3.3). (LLM, conf=0.84)
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Chronic mesenteric ischemia: Clinical practice guidelines from the Society for Vascular Surgery
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- Authors
- Mansukhani, N. A., Hekman, K. E., Yoon, D. Y., Helenowski, I. B., Hoel, A. W., Rodriguez, H. E., Pearce, W. H., Eskandari, M. K., & Tomita, T. M.
- Affiliations
- Northwestern University (US)
- Corresponding author
- Tomita, Tadaki M.
- ORCID
- Venue
- Annals of Vascular Surgery
- Publisher
- Elsevier BV
- Published
- 2018-04
- Volume
- 48
- Pages
- 159-165
- ISSN
- 0890-5096 (ISSN-L)
- PMC
- PMC5856595
- OpenAlex
- W2775240720
- Cited by
- 9
- References
- 14
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 1 · 2019: 1
- FWCI
- 0.56
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Vascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (T32HL094293, F32HL137292)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Surgery › Vascular anomalies and interventions
- Keywords
- body mass index, chronic mesenteric ischemia, mesenteric revascularization, obesity, overweight, all-cause mortality, long-term survival, endovascular revascularization, open surgical revascularization, venous conduit, peripheral arterial disease, chronic kidney disease, smoking, risk factors
- MeSH terms
- Adult, Aged, Aged, 80 and over, Blood Vessel Prosthesis, Chronic Disease, Female, Humans, Hypertension, Male, Middle Aged, Obesity, Postoperative Complications, Retrospective Studies, Risk Factors, Smoking, Time Factors, Veins, Comorbidity, Body Mass Index, Multivariate Analysis, Proportional Hazards Models, Treatment Outcome, Blood Vessel Prosthesis Implantation, Renal Insufficiency, Chronic, Kaplan-Meier Estimate, Endovascular Procedures, Peripheral Arterial Disease, Mesenteric Ischemia
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