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Association of Obesity Severity With Cardiometabolic and Renal Disease Burden in the United States
No full textObjective This study examined the association between obesity severity and cardiometabolic and renal disease, using BMI as a surrogate for obesity severity. Methods This is a cross-sectional study using data from the United States Behavioral Risk Factor Surveillance System (BRFSS), 2011–2023. Survey-weighted logistic regression estimated odds ratios (OR) for the diagnosis of diabetes, hypertension, hyperlipidemia, kidney disease, myocardial infarction, stroke, and coronary artery disease among increasing BMI categories. Results Higher BMI was associated with increased odds of all conditions. For BMI ≥ 50 kg/m2, odds were notably elevated for diabetes (OR 8.32; 95% CI: 7.78–8.91), hypertension (OR 6.07; 95% CI: 5.58–6.61), and kidney disease (OR 3.60; 95% CI: 3.21–4.03). The odds of cardiovascular disease also rose substantially, including myocardial infarction (OR 2.89; 95% CI: 2.56–3.28) and coronary artery disease (OR 3.44; 95% CI: 3.08–3.84). Mean age at diabetes diagnosis decreased with increasing BMI, from 52.2 years in Class I to 45.3 years in Class IV obesity. Conclusions Obesity severity is incrementally associated with cardiometabolic and renal disease burden, particularly among adults with BMI ≥ 50 kg/m2. These findings highlight the urgent need for early, aggressive interventions targeting individuals with all classes of obesity
Does Pelvic Angioembolization Increase Pelvic Ischemic Complications? A Multicenter American Association for the Surgery of Trauma Study
No full textBACKGROUND: Controversy exists about whether pelvic angioembolization (PAE) causes ischemic complications of the pelvis and whether selective vs nonselective embolization influences the risk of these complications. STUDY DESIGN: We conducted a multicenter prospective observational study of adult blunt trauma patients with pelvic fractures who underwent angiography for 55 months. Patients who underwent angiography were divided into 4 groups: no embolization (No-Embo), selective embolization (Sel), unilateral nonselective embolization (Non-Sel), and bilateral Non-Sel embolization (B-Non-Sel). The primary outcome was ischemic complications, defined as gluteal skin and muscle necrosis, pelvic abscess, pelvic wound infection, pelvic wound breakdown, and osteomyelitis of the pelvis or femoral head. RESULTS: Of the 460 patients undergoing angiography, pelvic ischemic complications occurred in 45 patients (9.8%). Of these 45 patients, 4 were in the No-Embo group (5.1%), 24 (10.0%) in the Sel group, 11 (15.1%) in the Non-Sel group, and 6 (8.8%) in the B-Non-Sel. There was no significant difference when comparing the groups on univariate analysis (p = 0.23), multivariable analysis (Sel odds ratio [OR] = 2.16, p = 0.3; Non-Sel OR = 4.17, p = 0.07; B-Non-Sel OR = 1.00, p = 0.99) nor when comparing each complication individually. CONCLUSIONS: The current study is the largest to date of blunt pelvic fracture patients undergoing angiography. On comparing those not embolized with those selectively and nonselectively embolized, we found no association between pelvic angioembolization and pelvic ischemic complications. The decision of when and where to embolize should be individualized to the injury encountered and the stability of the patient
Impact of heart failure on postoperative outcomes in bariatric surgery
No full textBACKGROUND: The rising prevalence of heart failure (HF) and coexisting metabolic syndrome underscores the need to better understand how these conditions affect postoperative outcomes following metabolic and bariatric surgery. OBJECTIVES: To test the hypothesis that HF is associated with a greater risk of postoperative morbidity following metabolic and bariatric surgery. SETTING: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. METHODS: Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for the year 2023, postbariatric surgery complications of patients with a history of HF (n = 3422) were compared with patients without HF (n = 3422) using 1:1 propensity matching. Composite 30-day outcomes included length of stay (LOS) \u3e 5 days (LOS \u3e 5), infectious complications, serious complications, major adverse cardiovascular and cerebrovascular events, and death. RESULTS: Compared to matched controls, HF patients had higher incidence of prolonged LOS \u3e 5 days (4.49% vs. 1.66%, P \u3c .001) and increased rates of infectious (3.07% vs. 1.72%, P \u3c .001) and serious complications (5.26% vs. 2.70%, P \u3c .001). No differences were observed in major adverse cardiovascular events (.53% vs. .35%, P = .36) or 30-day mortality (.68% vs. .38%, P = .12). CONCLUSIONS: A history of HF in patients undergoing bariatric surgery is associated with significant increases in major postoperative morbidity. Efforts directed toward preoperative optimization of patients with HF and attentive postoperative monitoring as warranted. Further research is necessary to determine optimal perioperative management of patients with HF undergoing metabolic surgery
The Clinical Anatomy of the Vascular System | Ch 97
No full textSprouting theory suggests that arteries of a growing limb arise as a bud of the higher artery trunk. In the upper limb, subclavian arteries give off the axillary, brachial, and interosseous arteries, while the radial and ulnar arteries develop in later stages (Standring 2008)
The Clinical Anatomy of the Vascular System | Ch 12
No full textThe proximal portion of the right subclavian artery arises from the right side of the fourth aortic arch, while the distal portion arises from the right seventh intersegmental artery. The left subclavian artery arises from the left seventh intersegmental artery. Angiogenesis, driven by hypoxia and growth factors, leads bilaterally to the formation of the thyrocervical trunks from the subclavian arteries; this process is complete by the fourth week of gestation (Sadler 2019)
The Clinical Anatomy of the Vascular System | Ch 4
No full textThe ascending pharyngeal artery (Fig. 4.1) has a complex course as it supplies many different areas of the head and neck including the posterior fossa of the skull base, the viscerocranium, the pharynx, the middle ear, and also the cervical spine. Furthermore, it forms several clinically significant anastomoses distally with other vascular territories. Because of rather than despite its complicated nature, the ascending pharyngeal artery can be a rewarding subject of study for the reader seeking a comprehensive understanding of head and neck anatomy
