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Treatment Outcomes in Octogenarians with Chronic Limb-Threatening Ischemia after Infrainguinal Bypass Surgery or
Koichi Morisaki1, Daisuke Matsuda2, Atsushi Guntani3
1Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Insights
Elderly patients (≥ 80 years) with chronic limb-threatening ischemia (CLTI) show lower survival rates after revascularization compared to younger patients. However, limb salvage remains comparable, suggesting potential benefits for select older individuals.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Cardiovascular Research
Background:
- Chronic limb-threatening ischemia (CLTI) poses significant challenges, particularly in elderly populations.
- Revascularization is a key treatment for CLTI, but outcomes in patients aged 80 years and older require specific analysis.
Purpose of the Study:
- To compare clinical outcomes of revascularization for CLTI in patients aged ≥ 80 years versus those < 80 years.
- To evaluate the impact of age on overall survival, amputation-free survival, limb salvage, and postoperative complications.
Main Methods:
- Retrospective analysis of 789 patients undergoing infrainguinal revascularization for CLTI (2015-2021).
- Comparison of outcomes between patients aged ≥ 80 years and < 80 years.
- Propensity score matching was used to control for baseline differences.
Main Results:
- Patients aged ≥ 80 years had significantly poorer 2-year overall survival (OS) after both bypass surgery (BSX) and endovascular therapy (EVT).
- No significant difference in 2-year limb salvage (LS) rates was observed between the age groups for either BSX or EVT.
- Amputation-free survival (AFS) was comparable for patients with 0-1 risk factor, but poorer in the ≥ 80 years group with 2-4 risk factors, particularly after BSX.
Conclusions:
- While older age (≥ 80 years) is associated with reduced overall survival in CLTI patients undergoing revascularization, limb salvage rates are maintained.
- Elderly patients with fewer comorbidities (0-1 risk factor) may still benefit from revascularization, showing similar AFS and complication rates to younger counterparts.
- Careful patient selection is crucial for optimizing outcomes in the elderly CLTI population.
Background:
This study aimed to analyze the clinical outcomes after revascularization for chronic limb-threatening ischemia (CLTI) in patients aged ≥ 80 years and < 80 years.
Methods:
We retrospectively analyzed multicenter data of 789 patients who underwent infrainguinal revascularization for CLTI between 2015 and 2021. The end points were 2-year overall survival (OS), amputation-free survival (AFS), limb salvage (LS), and postoperative complications.
Results:
A total of 90 patients aged ≥ 80 years and 200 patients aged < 80 years underwent bypass surgery (BSX), and 205 patients aged ≥ 80 years and 294 patients aged < 80 years underwent endovascular therapy (EVT). Before the propensity score matching, multivariate analyses showed that age ≥ 80 years, lower body mass index and serum albumin levels, nonambulatory status, and end-stage renal disease were independent risk factors for 2-year mortality in the BSX and EVT groups. After propensity score matching, the 2-year OS was better in the < 80 years cohort than in the ≥ 80 years cohort in both the BSX and EVT groups (P = 0.018 and P = 0.035, respectively). There was no difference in the 2-year LS rates between the < 80 years and the ≥ 80 years cohorts in both the BSX and EVT groups (P = 0.621 and P = 0.287, respectively). According to the number of risk factors, except for age ≥ 80 years, there was no difference in the 2-year AFS rates between the < 80 years and ≥ 80 years cohorts for the BSX and EVT groups with 0-1 risk factor (P = 0.957 and P = 0.655, respectively). However, the 2-year AFS rate was poor, especially in the ≥ 80 years cohort in the BSX with 2-4 risk factors (P = 0.015). The Clavien-Dindo ≥ IV complication rates tended to be higher in the ≥ 80 years cohort than in the < 80 years cohort only in the BSX with 2-4 risk factors (P = 0.056).
Conclusions:
Patients with CLTI aged ≥ 80 years had poorer OS than those aged < 80 years. However, there was no difference in LS between the ≥ 80 years and < 80 years cohorts in both the BSX and EVT groups. Although age ≥ 80 years was associated with poorer OS, patients with 0-1 risk factor may benefit from revascularization, including BSX, because no difference was observed in AFS or Clavien-Dindo ≥ IV complications.
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