Background/Objectives: Abdominal aortic aneurysm (AAA) repair is a prophylactic intervention aimed at preventing rupture. As the population ages, surgical decision-making becomes increasingly complex, especially in older and frailer patients. Imaging biomarkers, such as psoas muscle area (PMA) and density (PMD), have been proposed as surrogates for frailty and potential predictors of surgical outcomes. However, their clinical utility remains uncertain. Methods: In this retrospective, single-center study, we evaluated 199 patients who underwent elective AAA repair between 2015 and 2019. Preoperative computed tomography angiography (CTA) was used to measure PMA and PMD at the level of the third lumbar vertebra. Lean psoas muscle area (LPMA) was calculated as the product of PMA and PMD. Sarcopenia was defined as the lowest tertile of each measurement. Outcomes were assessed using Fisher’s exact test, Kaplan–Meier survival analysis, and logistic regression. Results: No significant associations were found between PMA, PMD, or LPMA and early or late postoperative complications or mortality. Conclusions: Psoas muscle indices, measured on routine CTA scans, do not reliably predict postoperative outcomes in AAA patients. These findings suggest that further studies integrating broader clinical and functional assessments are needed to improve risk stratification and inform preoperative decision-making in this patient population.

Objectives: To analyze the effect of abdominal aortic aneurysm (AAA) diameter on late complication occurrence and survival in patients following endovascular aneurysm repair (EVAR). Methods: The study was a retrospective cohort analysis with a prospective follow-up of 176 patients diagnosed with unruptured AAA who underwent EVAR from 2016 to 2024. Preoperative computed tomography (CT) images were used to measure maximal aneurysm diameter. Prospective follow-up data were collected post-EVAR at 1 month, 6 months, and annually through clinical evaluations and imaging studies. The mean follow-up duration was 26 months. For statistical purposes, the group was divided into tertiles based on aneurysm size. This study was intentionally focused on aneurysm size as an isolated imaging parameter, and did not incorporate other known predictors of complications, such as neck morphology or device-related variables. As such, key limitations include the single-center design, relatively small sample size, and lack of data on anatomical features beyond maximum diameter. Results: Kaplan–Meier survival analysis demonstrated that patients in the highest tertile of aneurysm size experienced significantly higher rates of long-term adverse outcomes compared to those in the lower two tertiles, both in terms of late complications (log-rank p = 0.049) and all-cause mortality at 36 months (p = 0.022). In multivariate logistic regression, the occurrence of late complications was independently associated with symptomatic presentation (p = 0.003, OR = 3.616, 95% CI: 1.533–8.529) and acute admission (p = 0.033, OR = 0.345, 95% CI: 0.130–0.916). The largest aneurysms were significantly associated with late endoleak (p = 0.041, OR = 5.365, 95% CI: 1.071–26.871). Conclusions: This study demonstrates that AAA size is an independent predictor of both late complications and long-term survival following EVAR. Patients with larger aneurysm diameters experienced significantly higher rates of late complications and reduced overall survival.

Background: Sarcopenia is linked with high rates of adverse surgical outcomes, and computed tomography angiography (CTA)-based psoas measurements are used as imaging sarcopenia surrogates. Their prognostic value in patients with chronic limb-threatening ischemia (CLTI) undergoing revascularization remains uncertain. Objectives: To evaluate whether CTA-derived psoas muscle indices predict complications and mortality after lower-limb revascularization for CLTI. Methods: We performed a retrospective cohort study of consecutive adults who underwent open, hybrid, or endovascular revascularization for CLTI at a single tertiary center (March 2018–December 2021). Psoas muscle area (PMA) and density (PMD) were measured preoperatively on CTA at the mid-L3 vertebral level. Psoas muscle index (PMI) was calculated as PMA/height². Patients were stratified by tertiles for each index (lowest tertile = “sarcopenic” vs. upper two tertiles). Outcomes included early in-hospital complications, late complications, overall complications, late mortality, and overall mortality. Group comparisons used χ²/Fisher tests with false discovery rate (FDR) adjustment; multivariable logistic regression with AIC-guided selection assessed independent predictors. Results: A total of 234 patients were included (median age 68 years; 65.4% men). Early complications occurred in 15.8%; late complications in 70.3%; overall mortality during follow-up was 26.6% (38/143 within follow-up data). In tertile analyses, none of the psoas-derived measures were significantly associated with early complications, late complications, overall complications, or mortality after FDR correction. Lower PMD showed consistent but non-significant trends toward higher late complications (84% vs. 64%), overall complications (87% vs. 72%), overall mortality (38% vs. 21%), and late mortality (37% vs. 20%) (all p < 0.05 unadjusted; all p_adj ≥ 0.139). In multivariable models, PMA, PMD, and PMI were not independent predictors of any outcome. Conclusions: In this retrospective cohort study, preoperative CTA-derived psoas indices were not independent predictors of early, late, or overall complications, nor of in-hospital or follow-up mortality after revascularization for chronic limb-threatening ischemia. Although lower psoas muscle density showed consistent trends toward higher risk, these associations did not reach statistical significance after adjustment. Taken together, our findings suggest that psoas-based measures have limited prognostic value in this setting and should be interpreted cautiously, while their potential role warrants confirmation in larger, prospective studies.

Abdominal aortic aneurysm (AAA) carries a rupture-related mortality exceeding 80% when untreated. Percutaneous endovascular aortic aneurysm repair (pEVAR) represents the current technical frontier, although evidence regarding its clinical and economic benefits remains heterogeneous. This narrative review of PubMed, Scopus, and Web of Science from inception to 1 August 2026 synthesises comparative data from 67 publications and four manufacturer websites to evaluate the clinical, quality-of-life, and economic outcomes of pEVAR against open femoral exposure. Current evidence suggests that pEVAR may serve as a feasible alternative to open femoral exposure, offering potential benefits regarding access-site morbidity, hospital length of stay, and early postoperative pain. While RCTs report pEVAR’s early perioperative advantages, evidence regarding long-term safety, anatomy, and costs remains predominantly observational. Additionally, pEVAR allows for locoregional anaesthesia, a strategy hypothesized to positively influence short-term outcomes in ruptured aneurysm emergencies, although prospective validation is required. However, maintaining these benefits relies heavily on overcoming the procedural learning curve and ensuring rigorous pre-procedural patient selection via computed tomography angiography to avoid severe vessel calcification and excessive depth. Available evidence suggests that in carefully selected patients, pEVAR yields an overall safety profile comparable to surgical cutdown, while potentially mitigating the risk of access-site complications.

Background/Objectives: Imaging-based markers of sarcopenia have emerged as potential indicators of frailty and predictors of clinical outcomes in patients with lower limb ischemia undergoing revascularization. However, the available evidence remains inconclusive. This systematic review aims to provide a comprehensive overview of current imaging-based approaches to sarcopenia assessment and to evaluate their relationship with clinical outcomes in this population. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) database: ID CRD420251229527. A literature search was performed in PubMed and Scopus to identify studies published between 1 January 2020 and 1 August 2025. Studies assessing imaging-derived markers of sarcopenia in adults undergoing revascularization for lower limb ischemia were included. Due to heterogeneity in imaging methods, sarcopenia definitions and reported outcomes, a narrative synthesis was performed. Results: Nine studies involving 2563 patients were included in this review. Computed tomography (CT) was the predominant imaging modality used for sarcopenia assessment, with muscle measurements most frequently obtained at the level of the third lumbar vertebra (L3). Commonly reported imaging-derived markers included the skeletal muscle index, psoas muscle-based parameters and muscle radiodensity. Assessment strategies varied across studies, particularly with respect to measurement techniques, anatomical landmarks and the thresholds used to define sarcopenia. Most studies reported an association between imaging-derived low muscle mass and increased long-term mortality; however, independent associations after multivariable adjustment were less consistent. Findings regarding postoperative complications and limb-related outcomes were limited and inconsistent. Conclusions: Current evidence suggests that imaging-derived muscle markers may provide additional prognostic information regarding long-term mortality in patients undergoing revascularization for lower limb ischemia, while associations with postoperative complications and limb-related outcomes remain inconsistent. However, the small number of retrospective studies and substantial methodological heterogeneity limit their comparability, highlighting the need for standardization in future research.