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

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.