Changes in Computed Tomography–Derived Calf Muscle Volume After Revascularization in Patients with Peripheral Artery Disease

Objective Although supervised exercise therapy improves walking performance in patients with peripheral artery disease (PAD), little is known about changes in skeletal muscle volume following revascularization. This study aimed to quantitatively assess changes in calf muscle volume before and after revascularization using the computed tomography (CT). Methods Between July 2020 and June 2025, 42 patients (84 limbs) with PAD who underwent revascularization were included. Only patients with unilateral symptomatic disease and a contralateral asymptomatic limb with a normal ankle-brachial index (ABI) were eligible. Calf muscle volume was measured using CT before and 1 month after revascularization. Preoperative muscle atrophy and postoperative muscle volume changes were evaluated by comparing affected and contralateral limbs. Results The mean age was 74.3 ± 8.2 years, and 32 patients (76%) were male. Intermittent claudication was present in 33 cases (79%), and chronic limb-threatening ischemia in 9 cases (21%). The mean ABI was 0.60 ± 0.23 in affected limbs, and 1.01 ± 0.07 in contralateral limbs before treatment. Preoperative mean calf muscle volume was 1078 ± 286 cm 3 in affected limbs and 1116 ± 301 cm 3 in contralateral limbs, corresponding to a mean atrophic rate of 97 ± 9%. After revascularization, the mean ABI in affected limbs improved to 1.01 ± 0.09, and postoperative mean calf muscle volume increased to1158 ± 302 cm 3 , corresponding to a mean change of 11 ± 36% ( p = .21). The increase in muscle volume was most pronounced after bypass surgery (54% increase, p = .04). No significant changes were observed in muscle volume on contralateral limbs. Conclusions Calf muscle volume showed a nonsignificant trend toward an increase after lower extremity revascularization in patients with PAD. These preliminary findings suggest that revascularization may influence skeletal muscle volume; however, the potential contribution of postoperative edema and the small sample size warrant cautious interpretation.