Outcomes of endovascular treatment in nonagenarians with symptomatic peripheral arterial disease

Background: To report the clinical outcomes of endovascular therapy in nonagenarians treated for symptomatic peripheral arterial disease (PAD). Patients and methods: This is a retrospective analysis of 81 nonagenarians (mean age 93±2.4 years) treated by endovascular therapy for chronic limb threatening ischemia (CLTI) or claudication between December 2017 and August 2023. The composite of amputation and/or death (amputation-free survival; AFS) was the primary endpoint. Technical success, mortality, major limb amputation, risk for Major Adverse Cardio-Cerebro-vascular Events (MACCE) and re-intervention during follow-up were additionally analysed. Results: Most patients presented with CLTI (n=75, 93%). Popliteal artery interventions were most frequently performed (n=59, 73%), followed by superficial femoral artery (n=57, 70%), tibial (n=49, 61%), aortoiliac (n=11, 14%) and common femoral artery (n=7, 9%) procedures. The technical success rate was 100% and the in-hospital mortality was 1% (n=1). At 24 months the AFS was 23.5%, while the major amputation and mortality rates were 4.9% and 75.3% respectively. In the same period the rate of MACCE was 74.1% and the freedom from re-intervention rate amounted to 85.2% The cox regression analysis revealed a lower AFS among males (HR:1.8, 95% CI: 1.06-3.03, p=0.03) and a higher risk for MACCE in patients on warfarin (HR:3.1, 95% CI:1.26-7.59, p=0.01). Conclusions: Despite the high technical success and the low amputation rates, a very high mortality rate at follow up was observed among nonagenarians undergoing endovascular procedures for PAD. Male gender and Warfarin administration increased the risk for adverse events.