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

Background: Preoperatively detected sarcopenia as reflected by psoas muscle area (PMA) is associated with postoperative mortality after abdominal aortic aneurysm (AAA) repair. We studied, whether changes in PMA and lean PMA (LPMA) after endovascular aortic repair (EVAR) are associated with postoperative survival. Methods: In 122 AAA patients treated between 2008 and 2016 (90% male; median age, 77.8 years; interquartile range, 11.5; rupture 2.5%) PMA and LPMA at L3 level were measured retrospectively from preoperative and 1- and 3-year follow-up computed tomography (CT) studies. The median duration of follow-up was 6.0 years (interquartile range, 3.5) and allcause mortality was 46.7%. Association of radiologic muscle parameters with all-cause mortality was evaluated with Cox regression. Clinical data were collected from an institutional database and patient record databases. Results: There was a significant decrease in PMA and LPMA at L3 level (mean, -4.4 cm(2) [-26.8%] for PMA and -130.4 cm(2) x Hounsfield units [-21.6%] for LPMA, respectively; P < .001) and the greatest decline occurred during the first postoperative year after EVAR. Relative PMA change during follow-up (Delta PMA/baseline CT muscle parameter) was independently associated with mortality in multivariable analysis (hazard ratio, 0.977 for a 1% unit increase; 95% confidence interval, 0.960-0.995; P = .011). Conclusions: The most significant loss of skeletal muscle occurs during the first year after EVAR. The relative change in PMA from baseline is an independent predictor of mortality. For every 10% unit increase in Delta PMA/baseline CT muscle parameter bilaterally, there was a 21% decrease in the probability of death during follow-up. Early detection (from CT studies) and prevention of sarcopenia may potentially improve survival in EVAR-treated patients.