Low Psoas Muscle Area is Associated with Increased Mortality and Spinal Cord Injury After Complex Endovascular Aortic Aneurysm Repair
Issued Date
2022-11-01
Resource Type
ISSN
08905096
eISSN
16155947
Scopus ID
2-s2.0-85135154697
Pubmed ID
35772667
Journal Title
Annals of Vascular Surgery
Volume
87
Start Page
430
End Page
436
Rights Holder(s)
SCOPUS
Bibliographic Citation
Annals of Vascular Surgery Vol.87 (2022) , 430-436
Suggested Citation
Doonan R.J., Bin-Ayeed S., Charbonneau P., Hongku K., Obrand D., Mackenzie K., Steinmetz O., Bayne J., Girsowicz E., Abraham C., Gill H. Low Psoas Muscle Area is Associated with Increased Mortality and Spinal Cord Injury After Complex Endovascular Aortic Aneurysm Repair. Annals of Vascular Surgery Vol.87 (2022) , 430-436. 436. doi:10.1016/j.avsg.2022.05.037 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85432
Title
Low Psoas Muscle Area is Associated with Increased Mortality and Spinal Cord Injury After Complex Endovascular Aortic Aneurysm Repair
Author's Affiliation
Other Contributor(s)
Abstract
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.
