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

## TL;DR

This study shows that delayed walking recovery and muscle loss after aortic surgery are linked to higher long-term death risk in older patients.

## Contribution

The study identifies delayed ambulation and sarcopenia progression as novel independent predictors of mortality after EVAR.

## Key findings

- Delayed ambulation (≥2 days) and sarcopenia progression (ΔPMI ≥6.09% decrease) independently predict mortality after EVAR.
- Patients with both delayed ambulation and sarcopenia progression had the worst survival outcomes.
- The findings suggest these factors can guide risk stratification and rehabilitation planning.

## Abstract

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).

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.

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.

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.