The role of CT-assessed sarcopenia and visceral adipose tissue in predicting long-term survival in patients undergoing elective endovascular infrarenal aortic repair

OBJECTIVES: To evaluate if ileo-psoas muscle size and visceral adipose tissue (VAT) can predict long-term survival after endovascular aneurysm repair (EVAR).

METHODS: Patients who underwent EVAR between 2004 and 2012 in a single centre were included. Total psoas muscle area (TPA), abdominal VAT area, subcutaneous adipose tissue (SAT), and total adipose tissue were measured on the preoperative CT. Primary endpoint was all-cause mortality. Values are presented as median and interquartile range or absolute number and percentage. Cox regression analyses were performed to assess the associations with mortality.

RESULTS: Two hundred and eighty-four patients could be included in the study. During a median follow-up of 8 (4-11) years, 223 (79.9%) patients died. Age (P ≤ .001), cardiovascular (P = .041), cerebrovascular (P = .009), renal diseases (P = .002), and chronic obstructive pulmonary disease (P ≤ .001) were independently associated with mortality. TPA was associated with mortality in a univariate (P = .040), but not in a multivariate regression model (P = .764). No significant association was found between mortality and TPA index (P = .103) or any of the adiposity measurements with the exception of SAT (P = .040). However, SAT area loss in a multivariate analysis (P = .875).

CONCLUSIONS: Assessment of core muscle size and VAT did not contribute to improving the prediction of long-term survival after EVAR.

ADVANCES IN KNOWLEDGE: The finding of this study contradicts the previously claimed utility of core muscle size and VAT in predicting long-term survival after EVAR.