Related Experiment Videos
Infrainguinal revascularizations in octogenarians and septuagenarians
1Albert Einstein College of Medicine at Yeshiva University and the Long Island Vascular Center, NY 11576, USA.
Insights
Infrainguinal bypass grafts offer excellent patency and limb salvage for octogenarians and septuagenarians. Cardiovascular events are higher post-revascularization but linked to atherosclerosis severity, not age.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Cardiovascular Research
Background:
- Severe atherosclerosis significantly impacts mortality and morbidity in octogenarians, often leading to limb-threatening conditions like claudication and loss.
- Advanced age and comorbidities can challenge the success of traditional limb-salvaging procedures in elderly patients.
Purpose of the Study:
- To evaluate the outcomes of infrainguinal bypass grafts in octogenarians and septuagenarians.
- To compare survival, primary patency, and limb salvage rates between these age groups and with control populations.
Main Methods:
- A retrospective analysis of femoropopliteal and femorotibial bypass grafts performed in 209 octogenarians and 383 septuagenarians.
- Determination of survival, primary patency, limb salvage, myocardial infarction, and stroke rates.
- Comparison of event rates with large control groups of octogenarians and septuagenarians.
Main Results:
- Five-year survival rates were 54% for octogenarians and 64% for septuagenarians, comparable to controls (89%).
- Five-year primary patency rates were 74% for octogenarians and 68% for septuagenarians, with limb salvage rates at 86% for both groups.
- Myocardial infarction and stroke rates were higher post-graft in both age groups compared to controls.
Conclusions:
- Revascularization in octogenarians and septuagenarians is associated with increased mortality and cardiovascular events, primarily due to atherosclerosis severity rather than age.
- Infrainguinal bypass grafts demonstrate excellent and similar patency rates in both octogenarians and septuagenarians.
- Limb salvage procedures are a viable and recommended option for the majority of octogenarian patients with severe atherosclerosis.
Objective:
Severe atherosclerosis is a major contributor for death in octogenarians and a cause of multiple vascular-related ailments, including claudication and limb loss. Advanced age and health may limit the success of limb-salvaging procedures. Mortality, morbidity, and outcome of infrainguinal grafts have been examined in octogenarians and septuagenarians.
Methods:
After 128 femoropopliteal and 99 femorotibial bypass grafts in 209 octogenarians and 242 femoropopliteal and 166 femorotibial bypass grafts in 383 septuagenarians, survival, primary patency, limb salvage, myocardial infarction and stroke rates were determined. The survival, myocardial infarction, and stroke rates of controls, 1514 octogenarians and 2011 septuagenarians, were compared.
Results:
After a bypass graft, 5-year survival of octogenarians (54%) and septuagenarians (64%) was similar (P >.2) and was 89% and 89% for controls. The 5-year primary patency rates were 74% for octogenarians and 68% for septuagenarians (P >.2). Five-year limb salvage rates were 86% for octogenarians and 86% for septuagenarians. After a bypass graft, the respective rates of myocardial infarction were 4.1% and 3.9% per year and of a stroke 3.2% and 3.2% per year for octogenarians and septuagenarians, which occurred more frequently (P <.05) than in controls.
Conclusions:
Death and cardiovascular events are higher after revascularization in octogenarians and septuagenarians, compared with controls, and are related to the severity of atherosclerosis and not age. Patency rates are excellent and similar. Limb salvage procedures should be considered for most octogenarians.