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

Abstract

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.

Cardiopulmonary exercise testing, computed tomography-derived body composition, systemic inflammation and survival after elective abdominal aortic aneurysm repair

“…Historically, it has been more extensively studied in patients with cancer, but recently an association between a poorer prognosis and preoperative CT-BC analysis has been described in patients with AAA. 9,10 The mechanism by which sarcopenia leads to poorer outcomes is poorly understood and is probably a complex interaction between reduced physiological reserve, increasing comorbidity and a chronic inflammatory state. 11 The relationship between objective measures of physiological fitness derived from CPEX and sarcopenia has been previously investigated in patients undergoing hepatobiliary resection.…”

“…Sarcopenia is a chronic condition of reduced muscle mass and function that can be quantified using computed tomography (CT)-derived body composition analysis (CT-BC). Historically, it has been more extensively studied in patients with cancer, but recently an association between a poorer prognosis and preoperative CT-BC analysis has been described in patients with AAA 9,10 …”

Evaluation of the prognostic value of computed tomography‐derived body composition in patients undergoing endovascular aneurysm repair

“…A relationship between pre-operative body composition analysis and clinical outcomes following EVAR has been reported, with some muscle parameters appearing to predict inferior post-operative survival, 19,20 though the evidence base is more limited than in patients with cancer. Studies in patients with AAA are limited by short duration of follow-up and consist largely of patients receiving EVAR for infrarenal asymptomatic AAA; there is a paucity of data assessing the importance of sarcopenia in patients undergoing complex F/B-EVAR and in emergency cases.…”