Peripheral artery disease is a prevalent illness affecting more than 200 million people worldwide. A commonly used technique to manage the condition has been open endarterectomy. However, in recent times, a shift towards minimally invasive techniques has resulted in endovascular intervention as a popular alternative. This review aims to assess the safety and efficacy of endovascular intervention when compared with endarterectomy. A systematic review of the articles published in PubMed, Ovid, Embase, and Scopus within the last 10 years was conducted. The PRISMA guidelines were adhered to, and the Newcastle-Ottawa and NICE quality assessment scales were used. A meta-analysis of proportions was performed using the RStudio software (RStudio Team (2021). RStudio: Integrated Development Environment for R, PBC, Boston, MA, USA). Twenty-six studies were included, with a total of 7126 patients (endovascular, 2496; endarterectomy, 4630). Technical success was greater for endarterectomy than endovascular intervention with an odds ratio of 0.38; 95% CI [0.27–0.54]. In terms of safety as well endovascular intervention was better than endarterectomy with an odds ratio of 0.22; 95% CI [0.15 to 0.31] for wound infection. Endovascular intervention is a safe and effective procedure; however, it cannot be considered superior to endarterectomy.
Frailty and myosteatosis are each prognostic of all-cause mortality (ACM) in patients with cancer. However, it is unclear whether myosteatosis adds value to frailty for predicting ACM. We assessed whether myosteatosis improves the predictive ability of frailty for ACM in older adults undergoing chemotherapy. This was a retrospective study of older adults (≥65 years) initiating chemotherapy between June 2015 and June 2022. Frailty was assessed using a 24-item frailty index (FI). Myosteatosis was evaluated via computed tomography scans at the third lumbar vertebra (L3).. Multivariable Cox regression and Uno’s c-statistic determined the predictive performance of the FI and myosteatosis. In total, 115 participants (mean age: 77.1 years) were included. Frailty alone (adjusted hazards ratio (aHR) = 1.68, 95% confidence intervals (CIs) = 1.03–2.72, p = 0.037) and myosteatosis alone (aHR = 2.14, 95%CI = 1.07–4.30, p = 0.032) exhibited similar performance (c-statistic = 0.66) in predicting ACM in multivariable analyses adjusted for age, sex, body mass index, and treatment intent. However, the highest predictive performance for ACM was observed after inclusion of both myosteatosis and frailty in the multivariable model (c-statistic = 0.70). Myosteatosis improves the performance of frailty for predicting ACM in older adults with cancer. Prospective studies to assess the effect of exercise on myosteatosis in older patients are warranted.