PMID- 28847658
OWN - NLM
STAT- MEDLINE
DCOM- 20171211
LR  - 20221207
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 66
IP  - 6
DP  - 2017 Dec
TI  - Perioperative psoas to lumbar vertebral index does not successfully predict 
      amputation-free survival after lower extremity revascularization.
PG  - 1820-1825
LID - S0741-5214(17)31783-4 [pii]
LID - 10.1016/j.jvs.2017.06.095 [doi]
AB  - BACKGROUND: Accurate and convenient methods for assessing a patient's risk of 
      postoperative morbidity and mortality comprise important tools in clinical 
      decision-making. Whereas some aspects of the patient's fitness for surgery can be 
      easily quantified, measurement of the patient's frailty is often difficult or 
      time-consuming. Previous research in the context of multiple types of major 
      surgical procedures has reported psoas-L4 vertebral index (PLVI) to be a useful 
      predictor of postoperative morbidity and mortality. METHODS: This retrospective 
      cohort study assessed the hypothesis that PLVI can predict amputation-free 
      survival (AFS) in patients undergoing open or endovascular lower extremity 
      revascularization. The records of all lower extremity revascularization patients 
      with preoperative computed tomography arteriography before revascularization 
      during a recent 6-year period were reviewed for demographic information and 
      outcomes. With use of embedded computed tomography software, the cross-sectional 
      area of the bilateral psoas muscles and vertebral body at the L4 level were 
      measured and used to calculate the PLVI. Univariate, multivariate logistic 
      regression, and Cox proportional hazards analyses were performed for the primary 
      outcome of AFS. RESULTS: During a 6-year period, 188 patents had preoperative 
      scanning, qualifying for inclusion in the study; 52% received open surgical 
      bypass and 48% received a percutaneous endovascular procedure, with a median 
      duration of follow-up of 12 months (interquartile range [IQR], 3-24 months). 
      Median bilateral psoas cross-sectional area was 24.9 cm(2) (IQR, 
      20.5-29.7 cm(2)), and mean PLVI was 1.74 (IQR, 1.39-2.05). Cox proportional 
      hazards analysis identified age (hazard ratio [HR], 1.07; 95% confidence interval 
      [CI], 1.01-1.14; P = .026), congestive heart failure (HR, 4.7; 95% CI, 1.29-16.9; 
      P = .019), and dyslipidemia (HR, 0.34; 95% CI, 0.12-0.99; P = .049) as 
      independent predictors of AFS loss, whereas PLVI was not (HR, 2.6; 95% CI, 
      0.83-8.39; P = .099). Kaplan-Meier life-table analysis demonstrated no 
      significant differences in survival between the highest and lowest PLVI cohorts 
      of patients. Hazard analysis showed concomitant congestive heart failure (HR, 15; 
      95% CI, 1.1-210; P = .042) and serum albumin concentration (HR, 0.16; 95% CI, 
      0.05-0.52; P = .0026) to be independent predictors of limb loss, whereas advanced 
      age (HR, 1.20; 95% CI, 1.07-1.35; P = .0026), bypass procedure (HR, 4.6; 95% CI, 
      1.04-21; P = .045), non-African American race (HR, 9.09; 95% CI, 1.02-100; 
      P = .048), and higher PLVI (HR, 10.9; 95% CI, 1.7-72; P = .013) predicted 
      increased risk of mortality. CONCLUSIONS: PLVI did not predict AFS after 
      intervention for peripheral arterial occlusive disease. This is contrary to the 
      ability of PLVI to predict perioperative and midterm survival after abdominal 
      aortic aneurysm repair and other major abdominal surgery.
CI  - Published by Elsevier Inc.
FAU - Nyers, Emily S
AU  - Nyers ES
AD  - Division of Vascular Surgery, Department of Surgery, Medical University of South 
      Carolina, Charleston, SC.
FAU - Brothers, Thomas E
AU  - Brothers TE
AD  - Surgical Service, Department of Veterans Affairs Medical Center, Charleston, SC. 
      Electronic address: brothete@musc.edu.
LA  - eng
PT  - Journal Article
PT  - Research Support, U.S. Gov't, Non-P.H.S.
DEP - 20170826
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - *Amputation, Surgical
MH  - Chi-Square Distribution
MH  - *Computed Tomography Angiography
MH  - Disease-Free Survival
MH  - *Endovascular Procedures/adverse effects/mortality
MH  - Female
MH  - Frail Elderly
MH  - Geriatric Assessment
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Limb Salvage
MH  - Logistic Models
MH  - Lower Extremity/*blood supply
MH  - Lumbar Vertebrae/*diagnostic imaging
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Peripheral Arterial Disease/diagnostic imaging/mortality/*surgery
MH  - Predictive Value of Tests
MH  - Proportional Hazards Models
MH  - Psoas Muscles/*diagnostic imaging
MH  - Radiographic Image Interpretation, Computer-Assisted
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Sarcopenia/*diagnostic imaging/mortality
MH  - Software
MH  - Time Factors
MH  - Treatment Outcome
MH  - *Vascular Surgical Procedures/adverse effects/mortality
EDAT- 2017/08/30 06:00
MHDA- 2017/12/12 06:00
CRDT- 2017/08/30 06:00
PHST- 2017/03/05 00:00 [received]
PHST- 2017/06/15 00:00 [accepted]
PHST- 2017/08/30 06:00 [pubmed]
PHST- 2017/12/12 06:00 [medline]
PHST- 2017/08/30 06:00 [entrez]
AID - S0741-5214(17)31783-4 [pii]
AID - 10.1016/j.jvs.2017.06.095 [doi]
PST - ppublish
SO  - J Vasc Surg. 2017 Dec;66(6):1820-1825. doi: 10.1016/j.jvs.2017.06.095. Epub 2017 
      Aug 26.