Key result
New or worsened sarcopenia after fenestrated endovascular aortic repair is linked to ~89% higher mortality.
Why the study?
Does peri-operative sarcopenia impact long-term survival in patients undergoing FEVAR for complex abdominal aortic aneurysms?
Observational (n=169)
No
Does peri-operative sarcopenia impact long-term survival in patients undergoing FEVAR for complex abdominal aortic aneurysms?
Effect estimate: HR 1.89 (95% CI 1.18-3.04)
p-value: p=0.009
Post-operative skeletal muscle loss following FEVAR is significant and independently associated with increased long-term mortality, highlighting the need for post-operative assessment and optimization.
Post-operative sarcopenia signals higher mortality risk; hypothesis-generating in Level 5 data and needs prospective validation.
OBJECTIVE: Sarcopenia, defined as loss of skeletal muscle mass and function, predicts adverse surgical outcomes. This study evaluated longitudinal changes in sarcopenia following fenestrated endovascular aortic aneurysm repair (FEVAR) and their impact on outcomes. METHODS: This retrospective, single centre study included patients who underwent FEVAR for complex abdominal aortic aneurysms between 2007 and 2022. Sarcopenia was defined using skeletal muscle area (SMA) cutoffs of < 144 cm RESULTS: This study included 169 patients (median age 74.7 years; 87.6% men) with median follow up of 4.8 years. Pre-operative sarcopenia prevalence was 20.7% (n = 35), which increased to 32.5% (n = 55) post-operatively, with statistically significant muscle loss (-6.6 ± 7.2%; p < .001). Subsequently, sarcopenia rates gradually declined to ∼27% over 3 years (1 year: -3.3 ± 9.2%, p < .001; 2 years: -3.7 ± 8.4%, p < .001; 3 years: -3.8 ± 10.7%, p = .006). Pre-operative sarcopenia did not impact thirty day outcomes or overall survival compared with non-sarcopenic patients at these time points (1 year: 88.4% vs. 95.2%; 3 years: 76.7% vs. 78.6%; 5 years: 55.8% vs. 61.9%, p = .090). Conversely, new or worsened post-FEVAR sarcopenia was associated with poorer survival (1 year: 90.6% vs. 95.2%; 3 years: 73.4% vs. 81.0%; 5 years: 53.1% vs. 64.8%; 7 years: 25.5% vs. 47.4%; 10 years: 2.1% vs. 15.5%, p = .001). Post-operative sarcopenia was a stronger predictor of overall mortality (hazard ratio [HR] 2.00, 95% confidence interval [CI] 1.30 - 3.10; p = .002) compared with pre-operative sarcopenia (HR 1.76, 95% CI 1.06 - 2.93; p = .030). In multivariate analysis, only post-operative sarcopenia remained significant (HR 1.89, 95% CI 1.18 - 3.04; p = .009) and was associated with higher seven year mortality (74.5% vs. 52.6%; p = .020) and ten year mortality (97.9% vs. 84.5%; p = .035). CONCLUSION: In this retrospective observational study, post-operative skeletal muscle loss following FEVAR was significant and was associated with long term mortality. This suggests that FEVAR carries a physiological burden warranting careful post-operative assessment and optimisation. Prospective multicentre studies are needed to establish mechanistic pathways and to determine whether interventions improve outcomes.
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El-Sayed et al. (2026) conducted an observational in Complex abdominal aortic aneurysms (n=169). Post-operative sarcopenia vs. Non-sarcopenic patients was evaluated on Overall mortality (HR 1.89, 95% CI 1.18-3.04, p=0.009). New or worsened post-operative sarcopenia following fenestrated endovascular aortic repair was independently associated with increased overall mortality (HR 1.89; 95% CI 1.18-3.04; p=0.009).
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