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Complex infrapopliteal revascularization in elderly patients with critical limb ischemia: impact of multidisciplinary

Lukla Biasi1, Sanjay D Patel2, Talia Lea2

  • 1Department of Vascular and Endovascular Surgery, Guy's St. Thomas' NHS Foundation Trust, London, UK - luklabiasi@gmail.com.

The Journal of Cardiovascular Surgery
|May 20, 2016
PubMed

Insights

Infra-popliteal revascularizations are effective for elderly patients with critical limb ischemia (CLI). Bypass surgery may offer better mid-term outcomes than endovascular treatment for these high-risk individuals.

Area of Science:

  • Vascular Surgery
  • Geriatric Medicine
  • Cardiovascular Interventions

Background:

  • Critical limb ischemia (CLI) incidence is increasing in the elderly population.
  • Limited evidence exists on infra-popliteal (IP) revascularization outcomes in octogenarian and nonagenarian CLI patients.

Purpose of the Study:

  • To evaluate the feasibility and effectiveness of IP revascularizations in elderly CLI patients.
  • To compare outcomes between bypass surgery and endovascular revascularization in this demographic.

Main Methods:

  • Analysis of a prospectively collected database of octogenarian and nonagenarian patients undergoing IP revascularization (bypass or angioplasty) for CLI (Rutherford 4-6) between 2010-2014.
  • Primary endpoints: amputation-free survival (AFS) and overall survival (OS) at 1 and 2 years.
  • Secondary endpoints: patency rates and limb-salvage (LS) rates analyzed by Kaplan-Meier, with univariate and multivariate analysis for outcome predictors.

Main Results:

  • 129 limbs in 120 patients (mean age 85 years) underwent IP revascularization.
  • Overall 1-year primary patency: 58%; 2-year: 34%. Overall 1-year AFS: 62%; 2-year: 46%. Overall 2-year LS: 84%. Perioperative mortality: 2%.
  • Bypass surgery showed potentially better mid-term secondary patency (72% vs 31% at 2 years) and AFS (68% vs 21% at 2 years) compared to endovascular treatment (P<0.001 for AFS). Diabetes and low eGFR predicted worse outcomes.

Conclusions:

  • Infra-popliteal revascularization (endovascular or surgical) is feasible and effective in octogenarians and nonagenarians with CLI.
  • A patient-tailored approach yields satisfactory outcomes in this high-risk group.
  • Bypass surgery may offer superior mid-term secondary patency and AFS rates.
Abstract

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