Predictors of All-Cause Mortality after Endovascular Aneurysm Repair: Assessing the Role of Psoas Muscle Cross-Sectional Area

Purpose: To evaluate psoas muscle area (PMA) as a predictor of all-cause mortality after endovascular aneurysm repair (EVAR) and compare it with other predictor variables. Material and Methods: Retrospective review of 407 patients who underwent EVAR over a 7-year period was performed. Demographics, comorbidity variables, and outcomes were collected. Preprocedure computed tomography scans were used to measure the PMA. Descriptive statistics summarized the demographic information and predictor variables. Kaplan-Meier analysis and univariate and multivariate Cox proportional regression analyses were performed. The main outcome measure was survival time. Results: Median survival time for patients with PMA in the lowest quartile of the distribution (≤1442 mm²) was 65.5 months (95% confidence interval [95% CI] 37.7–78.9) vs 91.2 months (95% CI 77.9–110.0 when PMA >1442 mm²). Multivariate analysis revealed lower PMA was associated with decreased survival (adjusted hazard ratio [AHR] 1.68; 95% CI 1.15–2.40, P =.006). Similarly, the presence of coronary artery disease (AHR 1.54, 95% CI 1.01–2.35, P =.045) and statin use after EVAR were associated with decreased survival (AHR 2.36, 95% CI 1.24–4.49, P =.009). Hyperlipidemia was associated with increased survival after EVAR (AHR 0.51, 95% CI 0.33–0.81, P =.004). Compared with patients with low body mass index (BMI) (<18.5), a normal BMI was associated with increased survival (AHR 0.21, 95% CI 0.08–0.53, P =.001). Conclusions: Although PMA is a risk factor for decreased survival time, other factors such as patient hyperlipidemia, presence of coronary artery disease, post-EVAR statin use, and BMI are also predictive of postoperative mortality.