Valente Ferdinando B A, Rinaldi Enrico, Santoro Annarita, Kahlberg Andrea, Chiesa Roberto, Melissano Germano
Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Eur J Vasc Endovasc Surg. 2025 Jun;69(6):857-864. doi: 10.1016/j.ejvs.2025.01.044. Epub 2025 Jan 30.
Sarcopenia is gaining interest in the pre-operative evaluation of patients with thoraco-abdominal aortic aneurysm (TAAA). Lean psoas muscle area (LPMA) has emerged as a way to measure sarcopenia and is a possible predictor of outcomes in endovascular TAAA repair. The aim of this study was to analyse the correlation between LPMA and outcomes of open TAAA repair.
Between 2018 and 2022, all consecutive elective patients who underwent open TAAA repair with an available adequate pre-operative computed tomography angiogram (CTA) were analysed retrospectively. The CTA data were used to measure LPMA. Pre- and post-operative variables were collected from all patients. Primary endpoints were death and major adverse events (MAEs) at 30 days and 90 days. The secondary endpoint was follow up mortality rate. Primary and secondary endpoints were correlated with LPMA.
A total of 179 patients were included, and 61.5% (110/179) were treated for extent II and III TAAA. Death at 30 days and 90 days was 6.1% and 8.9%, respectively. At a median follow up of 38 months (range: 12 - 60), the mortality rate was 17.2%. The proportion of patients with MAE occurrence at 30 days and 90 days was 29.1% and 37.4%, respectively. The median LPMA was 330 cm/Hounsfield unit (HU) (interquartile range 264, 442) and was significantly higher in men than in women (p = .001). Patients were divided according to the LPMA value into sarcopenic (< 350 cm/HU) and non-sarcopenic (> 350 cm/HU) groups, and in four quartiles. No statistically significant correlation between LPMA and death or MAEs was observed at 30 days and 90 days, and at follow up, but a trend towards an increased mortality rate was observed in patients with sarcopenia at 30 days (10%; 9/90) compared with patients without sarcopenia (2.2%, 2/89) (p = .059).
In this series of patients who underwent open TAAA repair, LPMA was found to be ineffective as an independent predictor of morbidity and mortality. Further studies are needed to clarify the role of this parameter as a predictor of adverse outcomes.
肌肉减少症在胸腹主动脉瘤（TAAA）患者的术前评估中日益受到关注。瘦腰大肌面积（LPMA）已成为一种测量肌肉减少症的方法，并且是血管腔内TAAA修复术后结果的一个可能预测指标。本研究的目的是分析LPMA与开放性TAAA修复术后结果之间的相关性。
回顾性分析2018年至2022年期间所有接受开放性TAAA修复且术前有可用的充分计算机断层扫描血管造影（CTA）的连续择期患者。利用CTA数据测量LPMA。收集所有患者的术前和术后变量。主要终点是30天和90天时的死亡和主要不良事件（MAE）。次要终点是随访死亡率。主要和次要终点与LPMA相关。
共纳入179例患者，61.5%（110/179）接受了II型和III型TAAA治疗。30天和90天的死亡率分别为6.1%和8.9%。中位随访38个月（范围：12 - 60个月），死亡率为17.2%。30天和90天发生MAE的患者比例分别为29.1%和37.4%。中位LPMA为330 cm/亨氏单位（HU）（四分位间距264, 442），男性显著高于女性（p = 0.001）。根据LPMA值将患者分为肌肉减少症组（< 350 cm/HU）和非肌肉减少症组（> 350 cm/HU），并分为四个四分位数。在30天和90天以及随访时，未观察到LPMA与死亡或MAE之间存在统计学显著相关性，但在30天时，肌肉减少症患者的死亡率有升高趋势（10%；9/90），而无肌肉减少症患者的死亡率为2.2%（2/89）（p = 0.059）。
在这一系列接受开放性TAAA修复的患者中，LPMA被发现作为发病率和死亡率独立预测指标无效。需要进一步研究以阐明该参数作为不良结局预测指标的作用。
