Abstract
OBJECTIVE: To evaluate the outcome of frail patients electively treated for abdominal aortic aneurysm (AAA) by open surgery with enhanced repair protocol (OSER) or endovascular aneurysm repair (EVAR). DESIGN: A retrospective study on frail AAA patients treated by EVAR and OSER was conducted. Patients were defined as frail if they present a normalized total psoas muscle area (nTPA) <500 mm2/m2. This study aimed to evaluate the association between sarcopenia and AAA-related as well as all-cause mortality rates. Secondary outcomes included reinterventions, operative time, blood transfusion, length of intensive care unit (ICU), and postoperative hospital stay. RESULTS: A total of 403 patients were included in the study, of which 122 (30.3%) had a nTPA < 500mm2/m2. Among them, 272 (67.5%) patients were treated with EVAR while 131 (32.5%) with OSER. Although EVAR was more frequently performed in sarcopenic patients than OSER (P<0.001), there were no significant differences between the 2 groups in terms of intraoperative and postoperative outcomes. Likewise, no statistically significant differences were found regarding mortality and reintervention rates at Kaplan-Meier analysis. However, sarcopenic patients undergoing OSER exhibited a significantly higher all-cause mortality rate at 1 month (P = 0.031) and cumulative follow-up (P = 0.004) compared to all other subgroups. CONCLUSIONS: The present experience demonstrates that less invasive approaches, but surgical or endovascular, are viable for AAA patients with no significant difference in intraoperative and immediate postoperative outcomes. Nevertheless, the potential of EVAR as a preferred strategy should be considered for frail patients based on ascertained sarcopenia.