Unit of Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy.
Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy.
J Vasc Surg. 2022 Nov;76(5):1407-1416. doi: 10.1016/j.jvs.2022.05.005. Epub 2022 Jun 3.
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.
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?"
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).
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.
本综述的主要目的是评估研究小组用于评估主动脉疾病患者中肌少症发生率的方法，以及将肌少症与接受择期血管内主动脉修复的患者生存相关联的证据基础的程度，并确定文献中的反复出现的主题或差距，以指导未来的研究。
按照 PRISMA（系统评价和荟萃分析的首选报告项目）扩展协议进行范围综述。纳入的研究均为完全用英文报告的研究（最后一次检索日期为 2022 年 4 月 30 日）。使用以下 PICO 问题构建搜索方程：“在患有主动脉疾病[人群]并接受血管内修复[干预]的患者中，影像学定义的肌少症[比较]的短期和长期结局的患病率和预后如何？”
共考虑了 31 项相关研究，其中 18 项纳入本范围综述。简而言之，12 项研究集中于标准血管内腹主动脉瘤修复（EVAR），2 项研究聚焦于胸主动脉 EVAR，4 项研究聚焦于复杂 EVAR。除两项研究外，其余研究均为回顾性设计，仅有一项研究纳入了来自多中心数据库的患者。肌少症通常使用 L3 或 L4 处的竖脊肌的 CT 血管造影（CTA）横截面积来定义，有时也会根据身高进行标准化。尽管用于定义肌少症的方法存在异质性，但总体而言，肌少症的患病率很高（范围为 12.5%-67.6%）。肌少症患者的死亡率更高（比值范围为 2.28[95%置信区间，1.35-3.84]至 6.34[95%置信区间，3.37-10.0]），不良事件发生率也更高（41% vs 16%；P=0.020）。
使用基于 CT 血管造影的骨骼肌质量测量来确定的肌少症在接受择期 EVAR、胸主动脉 EVAR 或复杂 EVAR 的患者中很常见。肌少症的存在已被证明具有负面的预后影响，增加了手术风险，并与较差的长期生存率相关。
