Developing sarcopenia predicts long-term mortality after elective endovascular aortic aneurysm repair

Area of Science:

• Vascular Surgery
• Radiology
• Gerontology

Background:

• Sarcopenia, measured by psoas muscle area (PMA), is linked to worse outcomes after abdominal aortic aneurysm (AAA) repair.
• The impact of sarcopenia changes after endovascular aortic repair (EVAR) on patient survival is not well understood.

Purpose of the Study:

• To investigate the association between changes in psoas muscle area (PMA) and lean PMA (LPMA) after EVAR and postoperative survival.
• To determine if sarcopenia progression post-EVAR is an independent predictor of mortality.

Main Methods:

• Retrospective analysis of 122 AAA patients undergoing EVAR between 2008-2016.
• Measurement of PMA and LPMA at the L3 vertebral level from preoperative and 1- and 3-year follow-up CT scans.
• Cox regression analysis to assess the association between muscle parameters and all-cause mortality over a median follow-up of 6.0 years.

Main Results:

• A significant decrease in PMA and LPMA was observed post-EVAR, with the most substantial loss occurring within the first year.
• Relative PMA change during follow-up was an independent predictor of mortality (HR, 0.977 per 1% unit increase; P = .011).
• A 10% increase in relative PMA loss was associated with a 21% reduction in mortality risk.

Conclusions:

• Skeletal muscle loss is most pronounced in the first year following EVAR.
• Relative change in PMA is a significant independent predictor of long-term mortality after EVAR.
• Early detection and management of sarcopenia in EVAR patients may enhance survival rates.