Impact of Delayed Recovery of Independent Ambulation and Sarcopenia Progression on Long-Term Outcomes Following Endovascular Aortic Aneurysm Repair.

AIM: To evaluate the long-term prognostic impact of delayed recovery of independent ambulation and post-operative sarcopenia progression in patients undergoing endovascular aortic aneurysm repair (EVAR).

METHODS

In this multicenter retrospective cohort study, 228 patients (mean age 78.1 ± 6.5 years; 82.5% male) who underwent EVAR for abdominal aortic aneurysm between January 2015 and December 2020 were included. Independent ambulation was defined as walking ≥ 15 m. Sarcopenia was assessed using the psoas muscle index (PMI) at L3 on CT, normalized by height squared. Baseline PMI was measured within 3 months preoperatively; post-operative sarcopenia progression was calculated as ΔPMI/baseline (% change from baseline to 6 months). The primary outcome was all-cause mortality, analyzed using multivariate Cox proportional hazards models.

RESULTS

Over a mean follow-up of 4.6 ± 2.2 years, 52 patients (22.8%) died. Mean time to independent ambulation was 1.4 ± 1.2 days, and mean ΔPMI/baseline decreased by 4.5% ± 8.9%. After adjusting for age, sex, nutritional status, and pre-operative sarcopenia, time to independent ambulation (HR 1.25; 95% CI 1.07-1.46; p = 0.004) and ΔPMI/baseline (HR 1.13; 95% CI 1.09-1.17; p < 0.001) were independent predictors of mortality. ROC analysis identified cut-offs of ≥ 2 days for ambulation and a decrease of ≥ 6.09% in ΔPMI/baseline. Patients meeting both criteria exhibited the poorest survival, representing delayed ambulation and marked sarcopenia progression.

CONCLUSIONS

Delayed recovery of independent ambulation and post-operative sarcopenia progression independently predict all-cause mortality after EVAR and may serve as clinically useful indicators for risk stratification and targeted rehabilitation.