Impact of endovascular thoracoabdominal aortic aneurysm repair on the development of sarcopenia.

Abstract

Sarcopenia has been identified as an independent risk factor for mortality in thoracoabdominal aortic aneurysm (TAAA) patients treated with fenestrated and branched endovascular aortic repair (f/bEVAR). The aim of this study was to investigate the impact of f/bEVAR with extensive aortic coverage on the development of sarcopenia. A single-center retrospective study was conducted including patients treated with f/bEVAR between 2016 and 2022. Preoperative computed tomography angiography and 1-year follow-up scans were used to measure lean psoas muscle area (LPMA, cm² × Hounsfield units [HU]) and lean erector spinae muscle area (cm² × HU) at the L3 vertebra level. A previously established cut-off value of preoperative LPMA was used to divide the patients into two groups: the sarcopenia group (SG; LPMA <350 cm² × HU) and the no SG (NSG; LPMA ≥350 cm² × HU). The primary outcome of this study was the development of sarcopenia after f/bEVAR. A total of 103 patients with types I, II, III, and V TAAAs were included (SG, n = 72; NSG, n = 31). SCI was more common in SG (24% vs 10%; P = .039). Three-year survival was 94 ± 3% with all four deaths occurring in the SG (P = .210). At 1 year after f/bEVAR, psoas muscle loss (LPMA loss, -24% vs -0.3%; P = .047) was more pronounced in the NSG, with 45% of the cases falling below the value of 350 cm³ × HU during the 12-month follow-up. Staged endovascular repair and chronic aortic dissection with fewer patent intercostal and lumbar arteries before f/bEVAR decreased LPMA loss during follow-up. For lean erector spinae muscle area, muscle loss was similar between groups (-27% vs -24%; P = .769). During the first year after f/bEVAR for TAAA, a significant loss of psoas and erector spinae muscle was detected after extensive aortic coverage. Individualized treatment planning with staged procedures and continued evaluation of sarcopenia status, including focused prevention and treatment of sarcopenia, could help to optimize outcomes. Further studies are needed to define the role of sarcopenia as a reliable stratification tool for mortality and major adverse events after f/bEVAR.