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Critical Limb Ischaemia in Octogenarians: Treatment Outcomes Compared With Younger Patients
Amaia Ormaechevarria1, Melina Vega de Céniga1, June Blanco1
1Department of Angiology and Vascular Surgery, Galdakao-Usansolo University Hospital, Bizkaia, Spain.
Insights
Elderly patients (≥80 years) with chronic limb threatening ischemia (CLTI) present with more comorbidities and receive conservative treatment more often. Both endovascular treatment and open surgery offer similar outcomes for these older patients.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Ischemia Research
Background:
- Chronic limb threatening ischemia (CLTI) management is complex, particularly in elderly populations.
- Octogenarian patients represent a growing demographic facing challenging treatment decisions for CLTI.
Purpose of the Study:
- To analyze the patient profile and outcomes of CLTI in octogenarian patients.
- To compare the characteristics and treatment results of CLTI between patients aged ≥80 years and those <80 years.
Main Methods:
- Retrospective cohort study of 512 CLTI patients (2013-2020).
- Patients stratified into <80 and ≥80 years age groups.
- Analysis of overall survival and limb salvage (LS) using Kaplan-Meier and Cox regression.
Main Results:
- Older patients (≥80) had higher comorbidity (heart/kidney disease) but less smoking/diabetes.
- Conservative treatment was more frequent in older patients (36.9% vs 18.0%).
- One- and two-year survival rates were lower in older patients (64.1%/51.3% vs 85.4%/73.0%). Limb salvage rates were 75.3%/72.1% vs 83.7%/79% respectively.
Conclusions:
- Octogenarian CLTI patients exhibit distinct profiles with increased comorbidities and reduced life expectancy.
- Endovascular treatment and open surgery demonstrated comparable survival and limb salvage rates in patients aged 80 and above.
Objective:
A growing proportion of patients with chronic limb threatening ischaemia (CLTI) are elderly, the most challenging for management decisions. The aim was to study the patient profile and outcome of CLTI in octogenarian patients, comparing them with younger patients.
Methods:
Retrospective cohort of consecutive patients hospitalised for CLTI with infrainguinal disease in a Spanish centre (2013-2020). Data on age, comorbidity, anatomical characteristics, and treatment were gathered. Patients were stratified according to age (<80 and ≥80 years). The primary outcomes were overall survival and limb salvage (LS), analysed using Kaplan-Meier and Cox regression.
Results:
: A total of 512 patients were enrolled: 305 were <80 years old with mean age 69.7 ± standard deviation (SD) 8.2 years, and 207 were ≥80 years old with mean age 85.3 ± SD 3.6 years. Smoking and diabetes mellitus were more frequent in younger patients (78.0% vs. 45.4%, p < .001; 68.5% vs. 59.5%, p = .037 respectively). Older patients had a higher prevalence of heart and kidney disease (70.5% vs. 57.0%, p = .002; 39.6% vs. 24.3%, p < .001, respectively). The arterial disease was femoropopliteal or tibial in 68.9% and 31.1% in patients <80 years and 58.9% and 41.1% in patients ≥80 years (p = .021). In younger patients, conservative treatment was indicated in 18.0%, endovascular treatment (ET) in 41.6%, and open or hybrid surgery (OS) in 40.3%; in patients ≥80 years these were 36.9%, 37.4%, and 25.7%, respectively (p <. 001). Mean follow up was 23.3 ± SD 17.4 months. One and two year overall survival was 85.4% and 73.0% in younger patients and 64.1% and 51.3% in patients ≥80 years (p < .001). LS was 83.7% and 79% at the same times in younger patients and 75.3% and 72.1% in older ones (p = .045). In younger patients ET led to worse LS than OS (p = .005) but not in older patients (p = .29).
Conclusion:
Patients ≥80 years with CLTI have higher comorbidity and lower life expectancy and receive conservative treatment more frequently than younger patients. ET and OS are associated with similar survival and LS in these older patients.
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