Comparative results of open lower extremity revascularization in nonagenarians

The average lifespan in the United States continues to lengthen. We have observed a similar trend in our patients, with an increased number of nonagenarians presenting for evaluation of vascular disease. This study evaluated outcomes of lower extremity revascularization in patients aged >or=90 years.

The vascular registry at Albany Medical College was retrospectively reviewed for all lower extremity bypasses performed between 1996 and 2006. We evaluated patient demographics, indications, procedure, patency rates, and complications. Patients were divided into groups based on age >or=90 years (>or=90 group) and <90 years (<90 group). Variables were evaluated by chi(2) analysis. Outcomes were prepared using life-table methods and compared with log-rank analysis.

During the last 10 years, 5443 lower extremity bypasses were performed on patients aged <90 years and 150 on patients aged >or=90 years. The <90 group had significantly more men (61.4% vs 29.3%) and was obviously younger, at 68 years (range 7-89 years) vs 92 years (range, 90-101 years). The <90 group had more comorbidities in terms of diabetes, active tobacco use, and hypercholesterolemia. No significant difference was noted in coronary artery disease or chronic renal insufficiency between the groups. Critical limb ischemia as an indication was significantly higher in the >or=90 group (149 [99%] vs 4472 [82%]; P < .0.5). Strikingly, the primary patency was significantly higher in the >or=90 group at 4 years (77% vs 62%; P < .05). Complication and amputation rates did not differ between the groups. Perioperative (15% vs 3%; P < .05) and 1-year (45% vs 11%; P < .05) mortality rates were significantly higher in the >or=90 group.

Lower extremity bypass for nonagenarians offers acceptable patency and limb salvage but at a significantly higher mortality rate.