Pre-operative Psoas Muscle Size Combined With Radiodensity Predicts Mid-Term Survival and Quality of Life After Fenestrated-Branched Endovascular Aortic Repair

Jussi M. Kärkkäinen, Emanuel R. Tenorio, Niku Oksala, Thanila Macedo, Indrani Sen, Bernardo C. Mendes, Randall R. DeMartino, Michael J. Jacobs, Barend Mees, Gustavo S. Oderich

Research output: Contribution to journalArticle

1 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)31-39
Number of pages9
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume59
Issue number1
DOIs
StatePublished - Jan 2020

Keywords

  • Branched
  • Endovascular aortic repair
  • Fenestrated
  • Frailty
  • Psoas
  • Sarcopenia

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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