Abstract 3316: Revascularization for Chronic Critical Lower Limb Ischemia in Octogenarians

Abstract

Objective: Advanced age is considered a relative contraindication for surgical revascularization in patients with peripheral arterial occlusive disease (PAD). Aim was to analyze usefulness of endovascular and surgical revascularization for chronic critical limb ischemia (CLI) in patients older than 80 years. Materials: Prospective cohort study of a consecutive series (01/1999 to 06/2004) of patients presenting with CLI. Revascularization cohorts were either surgical or endovascular with conservatively treated patients used as reference. Prospective follow-up after 30 days, 2, 6, and 12 months. Methods: Primary endpoint was sustained clinical success defined as categorical upward shift in clinical symptoms according to Rutherford without major amputation or need for repeated target extremity revascularization (TER). Secondary clinical success was defined accordingly including repeated TER. Mortality, major amputation and TER were secondary endpoints. Results were stratified for age (non-octogenarians [<80 years] vs octogenarians [≥80 years]). Cumulative outcome was determined by Kaplan-Meier method and differences assessed by log-rank tests. Multivariate analysis was performed by Cox proportional regression. Results: 376 patients (158 women, mean age 75.8 ± 10.7 years) with 416 critically ischemic limbs were analysed. Overall, 150 patients were octogenarians (39.9%). 85 limbs were treated surgically (31% octogenarians), and 207 limbs by endovascular means (46% octogenarians). Both sustained and secondary clinical success rates as well as limb salvage were higher in revascularization cohorts as compared to conservatively treated patients regardless of age category ( P =.013, P =.006, and P =.041, respectively). Mortality was significantly higher in octogenarians ( P =.006), and particularly high within 30-days after surgical revascularization (HR 5.35, 95%CI 1.15–24.9). Patient age category did not affect major amputation and TER rate in multivariate analysis. Conclusions: Individually tailored revascularization improves outcome of CLI in octogenarians comparably to non-octogenarians, even so endovascular revascularization should be preferred in octogenarians due to high 30-day mortality associated with surgery.