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Psoas Major Muscle Area as a Prognostic Marker in Peripheral Arterial DiseaseMuscle size in the lower back predicts survival for PAD patients

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Key Takeaway
Reduced psoas major muscle area is significantly associated with increased one-year mortality in PAD patients.

A systematic review and meta-analysis of seven retrospective cohort studies involving 2,290 patients evaluated the prognostic value of psoas major muscle morphometry. The study focused on patients undergoing surgical or endovascular revascularization specifically for peripheral arterial disease (PAD).

Analysis revealed a potential increase in early mortality among patients exhibiting sarcopenia or reduced muscle area at one month post-procedure. However, this specific finding did not reach statistical significance during the initial evaluation period.

In contrast, a significant association was identified between smaller psoas major dimensions and increased long-term mortality at the one-year mark. The data suggests that these measurements may serve as reliable indicators for identifying high-risk patients in clinical settings.

While limited by a small number of studies available for meta-regression, the findings highlight the importance of muscle mass assessment. Clinicians may use psoas area to better stratify risk and manage outcomes for patients with peripheral arterial disease.

How this fits prior evidence

This meta-analysis addresses a gap in identifying specific anatomical markers for prognosis in peripheral arterial disease. While previous coverage noted that patients with cardiovascular diseases have a measurable prevalence of active cancer across various conditions, this study focuses on the role of muscle morphometry as a prognostic indicator for mortality in PAD patients.

When patients undergo surgery or procedures to open blocked arteries in their legs, doctors look for ways to predict who might face the toughest road ahead. New data suggests that the size of a specific deep muscle called the psoas major could be a key indicator of a patient's long-term health.

Researchers looked at 2,290 adults with peripheral arterial disease (PAD). They found that patients with a smaller psoas muscle area had a significantly higher risk of death one year after their procedure. While the data for deaths within the first month was less certain and not statistically significant, the link to long-term mortality was clear.

This finding suggests that measuring muscle size could help doctors identify high-risk patients sooner. However, because the analysis relied on a small number of studies, more research is needed to confirm these patterns. This is an observation of risk, not a test of a new treatment.

What this means for you:
A smaller psoas muscle area is linked to higher one-year mortality in patients with peripheral arterial disease.

Common questions

What is the psoas muscle and why does it matter?

The psoas major is a deep muscle in the lower back and hip area. In this study, researchers found that the size of this muscle could serve as a marker to predict survival for patients with peripheral arterial disease (PAD) after they undergo surgery or other procedures to open their arteries.

How does muscle size affect outcomes for PAD patients?

The study found that a smaller psoas major muscle area was linked to an increased risk of death one year after treatment. While the link to mortality within the first month was not statistically significant, the long-term data showed a clear association between smaller muscle size and higher mortality.

Is this finding used to change how patients are treated?

This study shows an association between muscle size and survival risk, but it was not a trial of a new treatment. Because the analysis included a small number of studies, these results should be discussed with a doctor to understand what they mean for specific patient care.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
IntroductionAlthough frailty and reduced muscle mass are known to worsen surgical outcomes, the prognostic value of psoas major morphometry in peripheral arterial disease (PAD) remains incompletely defined. Sarcopenia, frequently quantified through cross-sectional psoas major muscle area on preoperative imaging, has emerged as a potential prognostic marker in patients undergoing lower-limb revascularization for PAD. This systematic review and meta-analysis aimed to evaluate whether reduced psoas major muscle area is associated with short- and long-term mortality following revascularization.MethodsA systematic search of MEDLINE, Scopus, and Web of Science identified observational studies assessing psoas muscle morphometrics in adults undergoing surgical or endovascular revascularization for PAD. Seven retrospective cohort studies (n = 2,290 patients) met the inclusion criteria. Study quality was assessed using the NHLBI tool. Random-effects meta-analyses were performed for 1-month and 1-year mortality. Heterogeneity was evaluated using I², and prediction intervals were calculated. Due to the small number of studies, meta-regression was not performed.ResultsThree studies contributed to the 1-month mortality analysis. The pooled estimate suggested a possible increase in early mortality among sarcopenic patients with a smaller psoas major area, but the association was not statistically significant (RR = 2.45; 95% CI 0.58–10.36; I2 = 38.3%; p = 0.22). Five studies reported 1-year mortality, demonstrating a significant association between reduced psoas major muscle area and increased long-term mortality (RR = 2.37; 95% CI 1.51–3.73; I2 = 43.4%; p 
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