Radiographic evaluation of the psoas and iliopsoas muscle as predictors for spinal cord ischemia after fenestrated and branched endovascular aortic repair

OBJECTIVE: This study aimed to investigate the association between sarcopenia and spinal cord ischemia (SCI) after fenestrated and branched endovascular aortic repair (F/B-EVAR) using two- and three-dimensional measurements of the psoas and iliopsoas muscles on preoperative computed tomography angiography (CTA). METHODS: HU). Area measurements were performed manually, whereas volume measurements were performed using an artificial intelligence-based segmentation tool. The primary outcome was to evaluate the predictive value of the measured sarcopenia surrogate markers for SCI occurrence. RESULTS: HU], P = .004) were lower in patients with SCI in the unadjusted analyses. On multivariable analysis, only psoas muscle area was independently associated with SCI (odds ratio: 0.815; 95% confidence interval: 0.680-0.977, P = .027). CONCLUSIONS: Psoas muscle area was independently associated with SCI after F/B-EVAR, indicating that patients with signs of sarcopenia on preoperative CTA may be at a higher risk for SCI. Volumetric iliopsoas muscle measurements were not better predictors of SCI than two-dimensional measurements of the psoas muscle area.