Accurate identification of elderly patients at risk for mortality may identify appropriate patients for preemptive rehabilitation, as well as better inform patients and providers decisions regarding the potential benefits of elective surgery.6 Therefore, sarcopenia bears the potential to become a useful tool that may ameliorate the surgical decision-making progress. Assessment of sarcopenia based on psoas muscle quality may be easily achieved in EVAR candidate using pre-operative cross-sectional imaging, which is usually available before the elective interventionThe aims of this study were: i) to identify the prevalence of sarcopenia in patients undergoing elective endovascular repair (EVAR) for intact abdominal aortic aneurysm (AAA); ii) to assess its prognostic impact on peri-operative morbidity and long-term survival; and iii) to estimate its diagnostic accuracy for prediction of five-year mortality following the intervention.

The lean psoas muscle area (LPMA; cm2xHU) was calculated on computed tomography angiography (CTA) by multiplying psoas muscle area and psoas muscle density. The main exposure variable for this study was presence of pre-operative sarcopenia (LPMA value <350), and the study cohort was divided in two groups for all subsequent analyses, accordingly. The primary endpoint was all-cause mortality.

The study cohort eventually comprised 338 patients who underwent elective EVAR for intact AAA. In the overall population, one-hundred fifty-four patients (45.5%) were classified as sarcopenic. At five years, the estimated survival rates were 52% vs 74% in sarcopenic and non-sarcopenic patients, respectively (p<.001). Using multivariate Cox Proportional Hazard regression, presence of sarcopenia was identified as independent predictor for all-cause mortality in the whole cohort (HR: 2.63, 95%CI: 1.43-3.36, p=.009),

Sarcopenia, defined as LPMA <350 as measured on pre-operative CTA, can be highly prevalent in patients undergoing elective EVAR. Although the intervention remains safe in the short-term, presence of sarcopenia was significantly associated to reduced long-term survival irrespective of patients' age.

-Lilja F et Al Editor's Choice - Trend-break in Abdominal Aortic Aneurysm Repair With Decreasing Surgical Workload.doi:10.1016/j.ejvs.2017.02.031 -Newton DH et Al, Sarcopenia predicts poor long-term survival in patients undergoing endovascular aortic aneurysm repair.doi:10.1016/j.jvs.2017.06.092 -Bahat G et Al, Cut-off points to identify sarcopenia according to European Working Group on Sarcopenia in Older People (EWGSOP) definition. Clinical Nutrition. doi:10.1016/j.clnu.2016.02.002 -Koter S et al. Increased hospital costs are associated with low skeletal muscle mass in patients undergoing elective open aortic surgery. doi:10.1016/j.jvs.2018.06.224 -Jones K, et al. Radiologically Determined Sarcopenia Predicts Morbidity and Mortality Following Abdominal Surgery: A Systematic Review and Meta-Analysis.doi:10.1007/s00268-017-3999-2 -Wagner D et al, Clinical and morphometric parameters of frailty for prediction of mortality following hepatopancreaticobiliary surgery in the elderly. doi:10.1002/bjs.10037 -Thurston B, et al.. Low total psoas area as scored in the clinic setting independently predicts midterm mortality after endovascular aneurysm repair in male patients. doi:10.1016/j.jvs.2017.06.085 -Li W et al.. Controlling Nutritional Status (CONUT) score is a prognostic factor in patients with resected breast cancer. doi:10.1038/s41598-020-63610-7 -Kärkkäinen JM et al. Pre-operative Psoas Muscle Size Combined With Radiodensity Predicts Mid-Term Survival and Quality of Life After Fenestrated-Branched Endovascular Aortic Repair. doi:10.1016/j.ejvs.2019.06.021 -D'Oria M, Oderich GS et al, Safety and Efficacy of Totally Percutaneous Femoral Access for Fenestrated-Branched Endovascular Aortic Repair of Pararenal-Thoracoabdominal Aortic Aneurysms. doi:10.1007/s00270-020-02414-8 -Wanhainen A et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. doi:10.1016/j.ejvs.2018.09.020 -Greenhalgh R. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. doi:10.1016/S0140-6736(04)16979-1 -Bahia SS et al. Systematic Review and Meta-analysis of Long-term survival After Elective Infrarenal Abdominal Aortic Aneurysm Repair 1969-2011: 5 Year Survival Remains Poor Despite Advances in Medical Care and Treatment Strategies. doi:10.1016/j.ejvs.2015.05.004 -Sweeting MI et al. Endovascular Repair of Abdominal Aortic Aneurysm in Patients Physically Ineligible for Open Repair: Very Long-term Follow-up in the EVAR-2 Randomized Controlled Trial. doi:10.1097/SLA.0000000000002392 -Drudi LM et al. Scoping review of frailty in vascular surgery. doi:10.1016/j.jvs.2018.10.053 -Donald GW et al. Preoperative frailty assessment predicts loss of independence after vascular surgery. doi:10.1016/j.jvs.2018.02.044 -Antoniou GA et al. Effect of Low Skeletal Muscle Mass on Post-operative Survival of Patients With Abdominal Aortic Aneurysm: A Prognostic Factor Review and Meta-Analysis of Time-to-Event Data.. doi:10.1016/j.ejvs.2019.03.020 -Indrakusuma R et al. Psoas Muscle Area and Sarcopenia - Bridging the Gap. doi:10.1016/j.ejvs.2019.03.032