Radiographically Quantified Sarcopenia and Traditional Cardiovascular Risk Assessment in Predicting Long-term Mortality after EVAR

• Published in: Journal of vascular surgery
• Main Authors: Paajanen, Paavo, Lindström, Iisa, Oksala, Niku, Väärämäki, Suvi, Saari, Petri, Mäkinen, Kimmo, Kärkkäinen, Jussi M
• Format: Journal Article
• Language: English
• Published: United States 31-03-2022
• Subjects: endovascular aortic repair; risk factors; psoas muscle; mortality; abdominal aortic aneurysm; sarcopenia
• ISSN: 1097-6809

This study evaluated radiographically quantified sarcopenia and patient's comorbidity burden based on traditional cardiovascular risk assessment as potential predictors of long-term mortality after endovascular aortic repair (EVAR).
The study included 480 patients treated with standard EVAR for intact infrarenal abdominal aortic aneurysms. Patient characteristics, comorbidities, aneurysm dimensions and other preoperative risk factors were collected retrospectively. Preoperative computed tomography was used to measure psoas muscle area (PMA) at L3 level. Patients were divided into three groups based on ASA-score and PMA. In high-risk group, patients had sarcopenia (PMA <8.0 cm
for males and <5.5 cm
for females) and ASA score 4. In medium-risk group, patients had either sarcopenia or ASA 4. Patients in the low-risk group had no sarcopenia and ASA score was less than 4. Risk factors for long-term mortality were determined using multivariable analysis. Kaplan-Meier survival estimates were calculated for all-cause mortality.
Patients in the high- and medium risk-groups were older than in the low-risk group (77±7, 76±6 and 74±8 years, respectively, p<0.01). Patients in the high-risk group had higher prevalence of coronary artery disease, pulmonary disease and chronic kidney disease. There were no differences in 30-day or 90-day mortality between the groups. The independent predictors of long-term mortality were age, ASA-score, PMA, chronic kidney disease and maximum aneurysm sac diameter. The estimated one-year mortality rates were 5±2% for the low-risk, 5±2% for the medium-risk and 18±5% for the high-risk group (p<0.01). Five-year mortality estimates were 23±4%, 36±3% and 60±6%, respectively (p<0.01). The mean follow-up time was 5.0±2.8 years.
Both ASA and PMA were strong predictors of increased mortality after elective EVAR. The combination of these two can be used as a simple risk stratification tool to identify patients in whom aneurysm repair or the intensive long-term surveillance after EVAR may be unwarranted.