{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T15:28:22Z","timestamp":1786375702212,"version":"build-2736575974"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"\n Introduction<\/jats:title>\n Although frailty and reduced muscle mass are known to worsen surgical outcomes, the prognostic value of psoas major morphometry in peripheral arterial disease (PAD) remains incompletely defined. Sarcopenia, frequently quantified through cross-sectional psoas major muscle area on preoperative imaging, has emerged as a potential prognostic marker in patients undergoing lower-limb revascularization for PAD. This systematic review and meta-analysis aimed to evaluate whether reduced psoas major muscle area is associated with short- and long-term mortality following revascularization.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A systematic search of MEDLINE, Scopus, and Web of Science identified observational studies assessing psoas muscle morphometrics in adults undergoing surgical or endovascular revascularization for PAD. Seven retrospective cohort studies (\n n<\/jats:italic>\n \u2009=\u20092,290 patients) met the inclusion criteria. Study quality was assessed using the NHLBI tool. Random-effects meta-analyses were performed for 1-month and 1-year mortality. Heterogeneity was evaluated using I\u00b2, and prediction intervals were calculated. Due to the small number of studies, meta-regression was not performed.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Three studies contributed to the 1-month mortality analysis. The pooled estimate suggested a possible increase in early mortality among sarcopenic patients with a smaller psoas major area, but the association was not statistically significant (RR\u2009=\u20092.45; 95% CI 0.58\u201310.36;\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200938.3%;\n p<\/jats:italic>\n \u2009=\u20090.22). Five studies reported 1-year mortality, demonstrating a significant association between reduced psoas major muscle area and increased long-term mortality (RR\u2009=\u20092.37; 95% CI 1.51\u20133.73;\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200943.4%;\n p<\/jats:italic>\n \u2009&lt;\u20090.001). Although point estimates remained directionally consistent across heterogeneous imaging methodologies and sarcopenia definitions, confidence intervals were wide, and the prediction interval for 1-year mortality crossed the null value, indicating uncertainty regarding the magnitude and consistency of the association across future settings. Insufficient data prevented quantitative synthesis of limb outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n A reduced psoas major muscle area was associated with increased 1-year mortality in patients undergoing lower-limb revascularization for PAD, supporting a potential role for psoas morphometry as a prognostic marker of long-term vulnerability. Although short-term mortality findings were inconclusive due to limited power, psoas morphometry may have value in preoperative risk stratification. Standardized definitions and prospective studies are needed before routine clinical integration can be recommended and to clarify whether targeted nutritional and rehabilitation strategies may improve outcomes.<\/jats:p>\n <\/jats:sec>\n \n Systematic Review Registration<\/jats:title>\n \n identifier CRD420251118644,\n https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251118644<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1879694","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:04:09Z","timestamp":1784095449000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Psoas Major muscle area as a prognostic marker in peripheral arterial disease: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Jo\u00e3o","family":"Fernandes-Carvalho","sequence":"first","affiliation":[{"name":"Faculty of Medicine of the University of Porto","place":["Porto, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o","family":"Braga-Sim\u00f5es","sequence":"additional","affiliation":[{"name":"Unidade de Sa\u00fade Familiar - UarcoS, Unidade Local de Sa\u00fade do Alto Minho EPE","place":["Viana do Castelo, Portugal"]},{"name":"Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho","place":["Braga, Portugal"]},{"name":"ICVS\/3B's-PT Government Associate Laboratory","place":["Braga\/Guimar\u00e3es, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Santos-Silva","sequence":"additional","affiliation":[{"name":"Department of Palliative Care and Pain Medicine, Faculty of Medicine, University of Coimbra","place":["Coimbra, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V\u00edtor","family":"S\u00e1-Martins","sequence":"additional","affiliation":[{"name":"NOVA Medical School | Faculdade de Ci\u00eancias M\u00e9dicas da Universidade Nova de Lisboa","place":["Lisboa, Portugal"]},{"name":"CHRC - Comprehensive Health Research Centre, NOVA Medical School | Faculdade de Ci\u00eancias M\u00e9dicas, Universidade Nova de Lisboa","place":["Lisboa, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Paulo","family":"Andrade","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of the University of Porto","place":["Porto, Portugal"]},{"name":"Department of Biomedicine - Unit of Anatomy, Faculty of Medicine of the University of Porto","place":["Porto, Portugal"]},{"name":"RISE-Health, Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto","place":["Porto, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of the University of Porto","place":["Porto, Portugal"]},{"name":"Faculty of Medicine of the University of Coimbra","place":["Coimbra, Portugal"]},{"name":"Community Palliative Care Team Gaia - Local Health Unit Gaia and Espinho","place":["Vila Nova de Gaia, Portugal"]},{"name":"Coimbra Institute for Clinical and Biomedical Research","place":["Coimbra, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o","family":"Rocha-Neves","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of the University of Porto","place":["Porto, Portugal"]},{"name":"Department of Biomedicine - Unit of Anatomy, Faculty of Medicine of the University of Porto","place":["Porto, Portugal"]},{"name":"RISE-Health, Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto","place":["Porto, Portugal"]},{"name":"Department of Vascular Surgery, Unidade Local de Sa\u00fade - Alto Ave","place":["Guimar\u00e3es, 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