Advertisement

Low Psoas Muscle Area is Associated with Increased Mortality and Spinal Cord Injury After Complex Endovascular Aortic Aneurysm Repair

      Background

      Low psoas muscle area (PMA) is associated with worse post-operative outcomes. Our objective was to evaluate the association of PMA and postoperative outcomes in patients undergoing fenestrated/branched endovascular aneurysm repair (F/BEVAR).

      Methods

      Patient characteristics, anatomical and clinical information, and post-operative outcomes were collected from patients undergoing F/BEVAR between 2005-February 2019 who were deemed too high-risk for open repair. PMA was measured using a validated web-based software (coreslicer.com). Post-operative outcomes were compared between patients with low PMA (lowest quartiles) and high PMA (highest quartiles).

      Results

      We included 129 patients with a mean age of 74.6 ± 8.1, 81.4% male, and a mean follow-up of 29.4 ± 32.2 months. Patients in the low PMA group were more likely to be female (33.8% vs. 3.1%, P < 0.0001), less likely to have hypertension (72.3% vs. 87.5%, P = 0.03), dyslipidemia (63.1% vs. 78.1%, P = 0.06), and a trend towards a greater history of endovascular aneurysm repair (4.6% vs. 0%, P = 0.08). There were no significant differences in aneurysm or device characteristics between groups. In a multivariate model including age, sex, aneurysm type, and presence of prophylactic spinal drain, the low PMA group had a significantly increased risk of spinal cord injury (odds ratio 12.7, 95% CI 1.1–143.6). There were no significant differences in other 30-day outcomes. When compared to the highest quartile, the lowest PMA quartile patients had a hazard ratio of 4.6 (95% CI 1.2–17.6) for mortality during follow-up in a model with age, sex, and aneurysm type. For each 1 cm2 increase in PMA, the HR was 0.90 (95% CI 0.82–0.99) for mortality during follow-up.

      Conclusions

      In high-risk patients undergoing F/BEVAR low PMA is associated with spinal cord injury and mortality during follow-up. We found no association between PMA and 30-day mortality. PMA measurement is a simple method to assess for sarcopenia and frailty and may be useful for risk stratification pre-operatively.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Annals of Vascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Van Calster K.
        • Bianchini A.
        • Elias F.
        • et al.
        Risk factors for early and late mortality after fenestrated and branched endovascular repair of complex aneurysms.
        J Vasc Surg. 2019; 69: 1342-1355
        • Doonan R.J.
        • Girsowicz E.
        • Dubois L.
        • et al.
        A systematic review and meta-analysis of endovascular juxtarenal aortic aneurysm repair demonstrates lower perioperative mortality compared with open repair.
        J Vasc Surg. 2019; 70: 2054-2064.e3
        • Cheng B.T.
        • Soult M.C.
        • Helenowski I.B.
        • et al.
        Sarcopenia predicts mortality and adverse outcomes after endovascular aneurysm repair and can be used to risk stratify patients.
        J Vasc Surg. 2019; 70: 1576-1584
        • Drudi L.M.
        • Phung K.
        • Ades M.
        • et al.
        Psoas muscle area predicts all-cause mortality after endovascular and open aortic aneurysm repair.
        Eur J Vasc Endovasc Surg. 2016; 52: 764-769
        • Drudi L.M.
        • Tat J.
        • Ades M.
        • et al.
        Preoperative exercise rehabilitation in cardiac and vascular interventions.
        J Surg Res. 2019; 237: 3-11
        • Afilalo J.
        • Alexander K.P.
        • Mack M.J.
        • et al.
        Frailty assessment in the cardiovascular care of older adults.
        J Am Coll Cardiol. 2014; 63: 747-762
        • Englesbe M.J.
        • Patel S.P.
        • He K.
        • et al.
        Sarcopenia and mortality after liver transplantation.
        J Am Coll Surg. 2010; 211: 271-278
        • Jones K.I.
        • Doleman B.
        • Scott S.
        • et al.
        Simple psoas cross-sectional area measurement is a quick and easy method to assess sarcopenia and predicts major surgical complications.
        Colorectal Dis. 2015; 17: O20-O26
        • Otten L.
        • Stobäus N.
        • Franz K.
        • et al.
        Impact of sarcopenia on 1-year mortality in older patients with cancer.
        Age Ageing. 2019; 48: 413-418
        • Keevil V.L.
        • Romero-Ortuno R.
        Ageing well: a review of sarcopenia and frailty.
        Proc Nutr Soc. 2015; 74: 337-347
        • Bouche K.G.
        • Vanovermeire O.
        • Stevens V.K.
        • et al.
        Computed tomographic analysis of the quality of trunk muscles in asymptomatic and symptomatic lumbar discectomy patients.
        BMC Musculoskelet Disord. 2011; 12: 65
        • Kuroki L.M.
        • Mangano M.
        • Allsworth J.E.
        • et al.
        Pre-operative assessment of muscle mass to predict surgical complications and prognosis in patients with endometrial cancer.
        Ann Surg Oncol. 2015; 22: 972-979
        • Zuckerman J.
        • Ades M.
        • Mullie L.
        • et al.
        Psoas muscle area and length of stay in older adults undergoing cardiac operations.
        Ann Thorac Surg. 2017; 103: 1498-1504
        • Mamane S.
        • Mullie L.
        • Piazza N.
        • et al.
        Psoas muscle area and all-cause mortality after transcatheter aortic valve replacement: the montreal-munich study.
        Can J Cardiol. 2016; 32: 177-182
        • Indrakusuma R.
        • Zijlmans J.L.
        • Jalalzadeh H.
        • et al.
        Psoas muscle area as a prognostic factor for survival in patients with an asymptomatic infrarenal abdominal aortic aneurysm: a retrospective cohort study.
        Eur J Vasc Endovasc Surg. 2018; 55: 83-91
        • Kärkkäinen J.M.
        • Oderich G.S.
        • Tenorio E.R.
        • et al.
        Psoas muscle area and attenuation are highly predictive of complications and mortality after complex endovascular aortic repair.
        J Vasc Surg. 2021; 73: 1178-1188.e1
        • Kärkkäinen J.M.
        • Tenorio E.R.
        • Oksala N.
        • et al.
        Pre-operative psoas muscle size combined with radiodensity predicts mid-term survival and quality of life after fenestrated-branched endovascular aortic repair.
        Eur J Vasc Endovasc Surg. 2020; 59: 31-39
        • Lindström I.
        • Khan N.
        • Vänttinen T.
        • et al.
        Psoas muscle area and quality are independent predictors of survival in patients treated for abdominal aortic aneurysms.
        Ann Vasc Surg. 2019; 56: 183-193.e3
        • Newton D.H.
        • Kim C.
        • Lee N.
        • et al.
        Sarcopenia predicts poor long-term survival in patients undergoing endovascular aortic aneurysm repair.
        J Vasc Surg. 2018; 67: 453-459
        • Juszczak M.T.
        • Taib B.
        • Rai J.
        • et al.
        Total psoas area predicts medium-term mortality after lower limb revascularization.
        J Vasc Surg. 2018; 68: 1114-1125.e1
        • Olson S.L.
        • Panthofer A.M.
        • Harris D.J.
        • et al.
        CT-derived pretreatment thoracic sarcopenia is associated with late mortality after thoracic endovascular aortic repair.
        Ann Vasc Surg. 2020; 66: 171-178
        • Alenezi A.O.
        • Tai E.
        • Jaberi A.
        • et al.
        Adverse outcomes after advanced EVAR in patients with sarcopaenia.
        Cardiovasc Intervent Radiol. 2021; 44: 376-383
        • Pillet J.
        • Chevalier J.M.
        • Rasomanana D.
        • et al.
        The principal artery of the psoas major muscle.
        Surg Radiol Anat. 1989; 11: 33-36
        • Ouchi K.
        • Oki Y.
        • Sakuma T.
        • et al.
        Risk of psoas muscle atrophy after endovascular aneurysm repair assessed by cross-sectional psoas muscle area.
        Cardiovasc Intervent Radiol. 2020; 43: 981-986