Abstract
Background: Peripheral artery disease (PAD), intermittent claudication, and impaired mobility lower patients’ quality of life, contributing to the loss of skeletal muscle. This study sought to investigate the impact of endovascular treatment (EVT) by measuring the mid-thigh level of muscle volume in above the knee PAD patients before and after EVT.Methods: In this prospective, observational study, symptomatic PAD patients with above the knee lesions who had intermittent claudication and were undergoing optimal medical treatment were enrolled. The mid-thigh level of muscle area was measured by computed tomography initially, and then 3 and 6 months after EVT. Patients were categorized into ipsilateral or bilateral based on clinical symptoms and initial ABI value. The muscle area in ischemic and non-ischemic legs were compared in ipsilateral PAD patients. The correlations between alterations in the total thigh muscle area and clinical characteristics were analyzed in univariable and multivariable analysis to investigate the factor contributing skeletal muscle loss.Results: A total of 22 patients were analyzed. The muscle area of the thighs increased after EVT. Fourteen patients had ipsilateral lesions and 8 had bilateral stenosis. In patients with ipsilateral lesions, the mid-thigh muscle area of ischemic lower limbs was significantly lesser than that of non-ischemic lower limbs (118.2±16.5 cm2 vs 124.0±17.3 cm2, p=0.0002). The thigh muscle area of ischemic lower limbs increased after EVT (before: 118.2±16.5 cm2 vs 3 months: 124.0±18.7 cm2, p=0.0166; before vs 6 months: 123.0±17.7 cm2, p= 0.0566), but this was not the case for non-ischemic lower limbs. Multivariate regression analysis revealed that baseline glycated hemoglobin was the only factor that negatively correlated with the change in the muscle area after 3 (β= -3.74, 95% confidence interval [CI] = -7.3 to -0.2, p=0.0417) and 6 months (β= -5.24, 95%CI = -10.1 to -0.4, p=0.03567). Muscle area significantly increased in normoglycemic HbA1c < 6.5 patients (before: 246.1±33.5 cm2, before vs 3 months: 249.6±34.6 cm2, p = 0.032, before vs 6 months: 250.6±35.7 cm2, p = 0.0455) while there was no significant alternation in hyperglycemic (HbA1c ≥ 6.5) patients (before: 225.2±43.4 cm2, 3 months: 224.6±44.8 cm2, 6 months: 222.2±45.5 cm2).Conclusions: Ischemia induces muscle atrophy in PAD patients. However, ischemic muscle atrophy was ameliorated after EVT in normoglycemic patients. There is a need for large scale trial to investigate the impact of EVT if it would protect or even delay skeletal muscle loss in all-comer population.
Stump length as related to atrophy and strength of the thigh muscles in trans-tibial amputees