Sirignano Pasqualino, Barillà David, Colonna Giulia, Pranteda Chiara, Pignataro Arianna, Setteducati Carmen Emanuela, Brizzi Stefano, Baronetto Noemi, Taurino Maurizio, Civilini Efrem
Vascular and Endovascular Surgery Unit, Sant'Andrea Hospital of Rome, Department of General and Specialistic Surgery, "Sapienza" University of Rome, Rome, 00135/00139, Italy.
Vascular and Endovascular Surgery Unit of Humanitas Clinical and Research Center-IRCCS, Rozzano Department of Biomedical Sciences, Humanitas University, Milan, 20089, Italy.
Eur J Cardiothorac Surg. 2025 Aug 1;67(8). doi: 10.1093/ejcts/ezaf241.
To evaluate the outcome of frail patients electively treated for abdominal aortic aneurysm (AAA) by open surgery with enhanced repair protocol (OSER) or endovascular aneurysm repair (EVAR).
A retrospective study on frail AAA patients treated by EVAR and OSER was conducted. Patients were defined as frail if they present a normalized total psoas muscle area (nTPA) <500 mm2/m2. This study aimed to evaluate the association between sarcopenia and AAA-related as well as all-cause mortality rates. Secondary outcomes included reinterventions, operative time, blood transfusion, length of intensive care unit (ICU), and postoperative hospital stay.
A total of 403 patients were included in the study, of which 122 (30.3%) had a nTPA < 500mm2/m2. Among them, 272 (67.5%) patients were treated with EVAR while 131 (32.5%) with OSER. Although EVAR was more frequently performed in sarcopenic patients than OSER (P<0.001), there were no significant differences between the 2 groups in terms of intraoperative and postoperative outcomes. Likewise, no statistically significant differences were found regarding mortality and reintervention rates at Kaplan-Meier analysis. However, sarcopenic patients undergoing OSER exhibited a significantly higher all-cause mortality rate at 1 month (P = 0.031) and cumulative follow-up (P = 0.004) compared to all other subgroups.
The present experience demonstrates that less invasive approaches, but surgical or endovascular, are viable for AAA patients with no significant difference in intraoperative and immediate postoperative outcomes. Nevertheless, the potential of EVAR as a preferred strategy should be considered for frail patients based on ascertained sarcopenia.
评估采用开放手术强化修复方案（OSER）或血管内动脉瘤修复术（EVAR）对腹主动脉瘤（AAA）进行择期治疗的虚弱患者的治疗结果。
对接受EVAR和OSER治疗的虚弱AAA患者进行回顾性研究。如果患者的标准化腰大肌总面积（nTPA）<500 mm2/m2，则定义为虚弱。本研究旨在评估肌肉减少症与AAA相关死亡率和全因死亡率之间的关联。次要结局包括再次干预、手术时间、输血、重症监护病房（ICU）住院时间和术后住院时间。
本研究共纳入403例患者，其中122例（30.3%）nTPA < 500mm2/m2。其中，272例（67.5%）患者接受了EVAR治疗，131例（32.5%）接受了OSER治疗。尽管肌肉减少症患者接受EVAR治疗的频率高于OSER（P<0.001），但两组在术中和术后结局方面无显著差异。同样，在Kaplan-Meier分析中，死亡率和再次干预率也没有统计学上显著差异。然而，与所有其他亚组相比，接受OSER治疗的肌肉减少症患者在1个月时的全因死亡率（P = 0.031）和累积随访时的全因死亡率（P = 0.004）显著更高。
目前的经验表明，侵入性较小的方法，无论是手术还是血管内治疗，对于AAA患者都是可行的，术中和术后即刻结局无显著差异。然而，基于已确定的肌肉减少症，对于虚弱患者应考虑将EVAR作为首选策略。
