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 Jan;59(1):31-39. doi: 10.1016/j.ejvs.2019.06.021. Epub 2019 Nov 9.

Abstract

Objective: To investigate the association between psoas muscle area (PMA) and density (PMD) with survival and quality of life (QoL) after fenestrated-branched endovascular aortic repair (F-BEVAR).

Methods: The study included 244 consecutive patients enrolled in a prospective study to investigate outcomes of F-BEVAR. Pre-operative computed tomography angiography was used to measure PMA (cm2) and PMD (Hounsfield unit [HU]) at the L3 level. Lean PMA (LPMA) was calculated (PMA × PMD). Patients were divided into two groups using the LPMA cut off point based on a Cox hazard model. Group A was defined as LPMA ≥350 (n = 79) and group B as LPMA < 350 cm2 × HU (n = 165). QoL was assessed at baseline and at 12 months using the Short Form-36.

Results: Patients in group A were younger (mean age 72 ± 8 vs. 76 ± 7 years; p < .001), more often male (95% vs. 59%; p < .001), and had higher body mass index (30 ± 6 vs. 27 ± 5 kg/m2; p = .001). There were no major differences in comorbidities, aneurysm extent, or procedural measures between the groups. Thirty day mortality (0% vs. 0.6%; p = 1.0) and major adverse event rates (15% vs. 24%; p = .18) were similar in groups A and B. At three years, patient survival was 94% ± 3% in group A and 75% ± 4% in group B (hazard ratio [HR] 0.20, 95% confidence interval [CI] 0.07-0.56; p = .002). The three-year survival difference was even more prominent in patients aged ≥75 years: 100% for group A and 72% ± 5% for group B (HR 0.12, 95% CI 0.02-0.86; p = .035). Patients in group A had significantly higher QoL scores at baseline and at 12 months. LPMA was the strongest independent predictor of survival during follow up in multivariable analysis (adjusted HR 0.59 per 1 standard deviation, 95% CI 0.40-0.87; p = .008).

Conclusion: A high LPMA was independently and strongly associated with better mid term survival and QoL after F-BEVAR. LPMA may help to identify the best candidates for F-BEVAR among elderly patients.

Keywords: Branched; Endovascular aortic repair; Fenestrated; Frailty; Psoas; Sarcopenia.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Aneurysm, Abdominal / complications
  • Aortic Aneurysm, Abdominal / mortality
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortic Aneurysm, Thoracic / complications
  • Aortic Aneurysm, Thoracic / mortality
  • Aortic Aneurysm, Thoracic / surgery*
  • Clinical Decision-Making / methods*
  • Computed Tomography Angiography
  • Endovascular Procedures / methods*
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Frail Elderly
  • Humans
  • Male
  • Middle Aged
  • Patient Selection
  • Prognosis
  • Prospective Studies
  • Psoas Muscles / diagnostic imaging
  • Psoas Muscles / physiopathology
  • Quality of Life
  • Retrospective Studies
  • Risk Assessment / methods
  • Risk Factors
  • Sarcopenia / complications
  • Sarcopenia / diagnosis*
  • Sarcopenia / physiopathology
  • Survival Analysis
  • Time Factors
  • Treatment Outcome