Impact of Total Psoas Area and Lean Muscular Area on Mortality after Endovascular Aortic Aneurysm Repair

Oliveira, Vânia Constâncio; Oliveira, Pedro Paulo Martins de; Moreira, Mario E.; Correia, Mafalda; Lima, Pedro; Silva, Joana Cruz; Pereira, Ricardo; Fonseca, Manuel

doi:10.1016/j.avsg.2020.09.004

Cited by 11 publications

(7 citation statements)

References 25 publications

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“…A summary of the included studies is shown in Table 1 . There were a total of 2563 patients included (2062 EVAR, 501 F/B-EVAR), of which 836 (33%) were defined as having radiological sarcopenia (585 EVAR (28% of total), 251 F/B-EVAR (50% of total)).One study (Oliveira et al 26 ) excluded female patients, whilst the remaining studies included both males and females. Inclusion and exclusion criteria were otherwise similar in all studies; all authors excluded patients undergoing procedures for non-aneurysmal disease.…”

Section: Resultsmentioning

confidence: 99%

“… Study n Definition of “Sarcopenic” cohort n sarcopenic Normalisation? Follow-up (mean) Data extraction Centres Technique of muscle analysis (Software, Thresholds, Level) Timing of CT Ikeda et al 25 324 elective EVAR PMA, ROC analysis 166 No 56.7 months Direct (HR) Single Aquarius (manual) NR L4 NR Oliveira et al 26 105 elective EVAR** PMA; Lowest tertile 35 No 27.6 months Direct (HR) Single Osirix (semi-automated) − 29 to + 150 L3 NR Thurston et al 27 191 elective EVAR PMI < 500 mm 2 /m 2 30 Height 2 NR Direct (HR) Multi Osirix (semi-automated) NR L3 NR Huber et al 28 407 elective EVAR PMA; Lowest quartile 102 No 39.0 months Direct (HR) Single Carestream (manual) NR L4 NR Kärkkäinen et al 29 244 elective F/B-EVAR …”

Section: Resultsmentioning

confidence: 99%

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The relationship between pre-operative psoas and skeletal muscle parameters and survival following endovascular aneurysm repair: a systematic review and meta-analysis

Bradley

Roxburgh

Guthrie

2022

Sci Rep

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Sarcopenia is characterised by chronically reduced skeletal muscle volume and function, and is determined radiologically by psoas and skeletal muscle measurement. The present systematic review and meta-analysis aims to examine the relationship between pre-operative CT-derived psoas and skeletal muscle parameters and outcomes in patients undergoing EVAR and F/B-EVAR for aortic aneurysm. The MEDLINE database was interrogated for studies investigating the effect of pre-operative CT-diagnosed sarcopenia on outcomes following EVAR and F/B-EVAR. The systematic review was carried out in accordance with PRISMA guidelines. The primary outcome was overall mortality. RevMan 5.4.1 was used to perform meta-analysis. PROSPERO Database Registration Number: CRD42021273085. Ten relevant studies were identified, one reporting skeletal muscle parameters, and the remaining nine reporting psoas muscle parameters, which were used for meta-analysis. There were a total of 2563 patients included (2062 EVAR, 501 F/B-EVAR), with mean follow-up ranging from 25 to 101 months. 836 patients (33%) were defined as radiologically sarcopenic. In all studies, the combined HR for all-cause mortality in sarcopenic versus non-sarcopenic patients was 2.61 (1.67–4.08), p < .001. Two studies reported outcomes on patients undergoing F/B-EVAR; the combined HR for all-cause mortality in sarcopenic versus non-sarcopenic patients was 3.08 (1.66–5.71), p = .004. Radiological sarcopenia defined by psoas or skeletal muscle parameters was associated with inferior survival in patients undergoing both EVAR and F/B-EVAR. Current evidence is limited by heterogeneity in assessment of body composition and lack of a consensus definition of radiological sarcopenia.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The relationship between pre-operative psoas and skeletal muscle parameters and survival following endovascular aneurysm repair: a systematic review and meta-analysis

Bradley

Roxburgh

Guthrie

2022

Sci Rep

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“…26 A subsequent study replicated these results, reporting a nearly four-fold increased mortality risk in EVAR patients with the lowest tertile of total psoas area compared to those in the highest tertile. 27 Thoracic sarcopenia in TEVAR patients has been shown to be correlated with psoas muscle area and can also provide an assessment of sarcopenia in TEVAR patients. 28 Although the preoperative utility of quantifying sarcopenia is limited by the need for CT imaging and an experienced imaging reader, it should be considered in conjunction with ECOG scoring, when available, to provide a clearer picture of operative risk.…”

Section: Discussionmentioning

confidence: 99%

Functional performance status and risk of cardiovascular events and mortality following endovascular repair of thoracic and abdominal aortic pathology

et al. 2021

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Objective To characterize the association of preoperative functional performance status based on Eastern Cooperative Oncology Group (ECOG) scoring with the risk of adverse cardiovascular events, vascular events, and mortality in patients undergoing EVAR and TEVAR. Methods Retrospective review of the Society for Vascular Surgery Vascular Quality Initiative, a large, multi-center, registry database was performed. All individuals undergoing EVAR ( n = 18,730) and TEVAR ( n = 6595) for non-ruptured aortic pathologies between 2014 and 2018 were eligible for analysis. Multivariable logistic regression was used to determine the association of pre-procedure ECOG functional performance status on risk of in-hospital adverse cardiovascular events, vascular events, and mortality. Results The number of operations complicated by adverse cardiovascular and vascular events was 480 (2.6%) and 190 (1.0%) for EVAR and 733 (11.1%) and 219 (3.3%) for TEVAR, respectively. There were 118 (0.6%) and 240 (3.6%) in-hospital deaths following EVAR and TEVAR, respectively. Patients with ECOG grades 3 or 4 undergoing EVAR were at increased risk of cardiovascular events (OR = 1.62; 95% CI = 1.09, 2.41) and one-year mortality (HR = 2.62; 95% CI = 1.92, 3.57) compared to those with ECOG grade 0. Patients undergoing TEVAR with ECOG grade 3 or 4 were at increased risk for both inpatient death (OR = 2.77; 95% CI = 1.56, 4.9) and one-year mortality (HR = 3.27, 95% CI = 2.06, 5.21). ECOG status was not associated with an increased risk of adverse vascular events following either EVAR or TEVAR. Conclusions Poor preoperative functional status as assessed by ECOG score is associated with an increased risk of adverse postoperative cardiovascular events following EVAR and a higher mortality risk following both EVAR and TEVAR. Functional status assessment may be useful for risk stratification and determining procedural candidacy prior to EVAR and TEVAR.

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“…Exclusion of fatty degeneration is another variable for calculation of TPA. To obtain more precise and pure muscle area, several studies have performed the same measurements using an attenuation threshold of −29 to 150 HU to exclude fatty degeneration 104–107 . Moreover, the concepts of TPA and TPI were often used interchangeably in previous studies on sarcopenia assessment 9,19,108–111 .…”

Section: Clinical Application Of Abdominal Ct In Diagnosing Sarcopeniamentioning

confidence: 99%

“…To obtain more precise and pure muscle area, several studies have performed the same measurements using an attenuation threshold of −29 to 150 HU to exclude fatty degeneration. [104][105][106][107] Moreover, the concepts of TPA and TPI were often used interchangeably in previous studies on sarcopenia assessment. 9,19,[108][109][110][111] For example, in the study by Peng et al, the TPA formula equals the total psoas major muscle area divided by the height square, which is the formula for calculation of TPI.…”

Section: Clinical Significance Of Abdominal Ct In Diagnosing Sarcopeniamentioning

confidence: 99%

Use of computed tomography for the diagnosis of surgical sarcopenia: Review of recent research advances

Xiao

Zhou

et al. 2022

Nut in Clin Prac

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Sarcopenia, also known as muscle decay, is associated with high morbidity among surgical patients. It is highly correlated with adverse clinical outcomes, such as increased postoperative complications, prolonged hospital stay, and increased mortality. Computed tomography (CT) is one of the main methods for diagnosing sarcopenia, which has the advantages of intuitiveness, rapidity, and accuracy. Clinical studies have shown that CT‐defined sarcopenia can help predict the clinical outcomes and prognosis of surgical patients and provide an important reference for the formulation of antitumor treatment protocols. In recent years, some scholars have tried to construct an intelligent CT‐based diagnostic model, which is expected to improve the diagnostic efficiency and establish standardized diagnostic criteria for CT‐defined sarcopenia. In this review, we summarize the recent progress in the understanding of the diagnosis of sarcopenia and its potential prognostic value in surgery.

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Impact of Total Psoas Area and Lean Muscular Area on Mortality after Endovascular Aortic Aneurysm Repair

Cited by 11 publications

References 25 publications

The relationship between pre-operative psoas and skeletal muscle parameters and survival following endovascular aneurysm repair: a systematic review and meta-analysis

The relationship between pre-operative psoas and skeletal muscle parameters and survival following endovascular aneurysm repair: a systematic review and meta-analysis

Functional performance status and risk of cardiovascular events and mortality following endovascular repair of thoracic and abdominal aortic pathology

Use of computed tomography for the diagnosis of surgical sarcopenia: Review of recent research advances

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