Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov;76(5):1407-1416.
doi: 10.1016/j.jvs.2022.05.005. Epub 2022 Jun 3.

Scoping review of radiologic assessment and prognostic impact of skeletal muscle sarcopenia in patients undergoing endovascular repair for aortic disease

Luca Mezzetto  1 , Mario D'Oria  2 , Kevin Mani  3 , Salvatore Scali  4 , Frederico Bastos Gonçalves  5 , Santi Trimarchi  6 , Jacob Budtz-Lilly  7 , Randall DeMartino  8 , Gianfranco Veraldi  1 , Davide Mastrorilli  1 , Cristiano Calvagna  9 , Beatrice Grando  9 , Daniele Bissacco  6 , Sandro Lepidi  9
Affiliations

Scoping review of radiologic assessment and prognostic impact of skeletal muscle sarcopenia in patients undergoing endovascular repair for aortic disease

Luca Mezzetto et al. J Vasc Surg. 2022 Nov.

Abstract

Objective: The primary objectives of our scoping review were to evaluate the methods used by research groups to assess the incidence of sarcopenia in patients with aortic disease and the extent of the evidence base that links sarcopenia to the survival of patients undergoing elective endovascular aortic repair and to identify the recurring themes or gaps in the literature to guide future research.

Methods: A scoping review in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) protocols extension for scoping reviews was performed. The available studies included those fully reported in English (last query, April 30, 2022). The following PICO question was used to build the search equation: "in patients with aortic disease [population] undergoing endovascular repair [intervention], what was the prevalence and prognosis of radiologically defined sarcopenia [comparison] on the short- and long-term outcomes?"

Results: A total of 31 studies were considered relevant, and 18 were included in the present scoping review. In brief, 12 studies had focused on standard endovascular aneurysm repair (EVAR), 2 on thoracic EVAR, and 4 on complex EVAR. All but two studies were retrospective in design, and only one study had included patients from a multicenter database. Sarcopenia had generally been defined using the computed tomography angiography (CTA) findings of the cross-sectional area of the psoas muscle at L3 or L4, sometimes with normalization against the height. Overall, despite the heterogeneity in the methods used for its definition, sarcopenia was highly prevalent (range, 12.5%-67.6%). The patients with sarcopenia had had higher rates of mortality (ratio ranged from 2.28 [95% confidence interval, 1.35-3.84] to 6.34 [95% confidence interval, 3.37-10.0]) and adverse events (41% vs 16%; P = .020).

Conclusions: Sarcopenia, as identified using computed tomography angiography-based measurements of the skeletal muscle mass, was prevalent among patients undergoing elective EVAR, thoracic EVAR, or complex EVAR. The presence of sarcopenia has been shown to have a negative prognostic impact, increasing the operative risk and has been linked to poorer long-term survival.

Keywords: Aortic aneurysm; Aortic disease; Endovascular repair; Outcomes; Sarcopenia; Scoping review.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None.

Figures

Figure 1.
Figure 1.
PRISMA flowchart of literature selection.
Figure 2.
Figure 2.
Computed tomography angiography of psoas muscle in sarcopenic and non-sarcopenic patients with abdominal aortic aneurysm.
See this image and copyright information in PMC

References

    1. Lilja F, Mani K, Wanhainen A. Editor’s Choice – Trend-break in Abdominal Aortic Aneurysm Repair With Decreasing Surgical Workload. European Journal of Vascular and Endovascular Surgery. 2017;53(6):811–819. - PubMed
    1. Wagner D, Büttner S, Kim Y, Gani F, Xu L, Margonis GA et al. Clinical and morphometric parameters of frailty for prediction of mortality following hepatopancreaticobiliary surgery in the elderly. British Journal of Surgery. 2016;103(2):e83–e92. - PubMed
    1. Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutr. 1997;127:990S–991S. - PubMed
    1. Thurston B, Pena GN, Howell S, Cowled P, Fitridge R. Low total psoas area as scored in the clinic setting independently predicts midterm mortality after endovascular aneurysm repair in male patients. Journal of Vascular Surgery. 2018;67(2):460–467. - PubMed
    1. D’Oria M, Wanhainen A, DeMartino RR, Oderich GS, Lepidi S, Mani K. A scoping review of the rationale and evidence for cost-effectiveness analysis of fenestrated-branched endovascular repair for intact complex aortic aneurysms. Journal of Vascular Surgery. 2020;72:1772–1782 - PubMed

Publication types