Abstract
Background: This study investigated whether lower extremity muscle atrophy and myosteatosis in patients with peripheral arterial disease (PAD) are correlated to postoperative outcomes, such as reintervention or amputation-free survival. Methods: In this single-center retrospective cohort study of 462 patients treated for peripheral arterial disease scheduled for intervention, muscle mass and the presence of fattening of the lower extremity muscles were measured semiautomatically in a single computed tomography slice of the treated leg. Binary logistic regression models and Cox proportional hazards models were used to determine the effect of muscle atrophy and myosteatosis on reintervention and amputation. Results: Muscle atrophy and myosteatosis increased in PAD patients with Fontaine class IV compared with Fontaine class IIa. In PAD patients with muscle atrophy or myosteatosis, no association was found with the reintervention rate or reintervention-free survival, but an association was found with amputation-free survival, even after adjustment for patient-related, disease-severity, and comorbidities-related factors. Conclusion: Muscle atrophy and mysosteatosis increased in PAD patients with increasing disease severity. Lower extremity muscle atrophy and myosteatosis are associated with amputation rate and amputation-free survival in PAD patients. No association with reintervention rate or reintervention-free survival was found. Muscle atrophy and myosteatosis may serve as additional risk factors in decision making in the often frail vascular patient.
Highlights
Peripheral arterial disease (PAD) and chronic limb-threatening ischemia (CLTI) are associated with impaired quality of life and poor life expectancy [1]
The aim of this study is to investigate the effect of muscle atrophy and myosteatosis on the risk of reintervention and amputation-free survival
This is a single-center retrospective cohort study of patients with peripheral arterial disease scheduled for an intervention of the lower limb between 1 January 2005 and 31 December 2017 at the University Medical Center Groningen (UMCG), a tertiary referral centre for vascular pathology located in the Northern region of The Netherlands
Summary
Peripheral arterial disease (PAD) and chronic limb-threatening ischemia (CLTI) are associated with impaired quality of life and poor life expectancy [1]. Generalized loss of skeletal muscle mass, known as sarcopenia, is strongly associated with PAD and overall survival [6,7,8]. In lower extremity PAD, muscle changes in the limbs are more pronounced and increase with disease severity [9]. This is most likely caused by a combination of decreased physical activity and hypoperfusion-induced ischemia. This study investigated whether lower extremity muscle atrophy and myosteatosis in patients with peripheral arterial disease (PAD) are correlated to postoperative outcomes, such as reintervention or amputation-free survival. Lower extremity muscle atrophy and myosteatosis are associated with amputation rate and amputation-free survival in PAD patients. Muscle atrophy and myosteatosis may serve as additional risk factors in decision making in the often frail vascular patient
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