With the advent of endovascular interventions, previous patients that were ineligible for lower limb revascularization can now receive treatment. As a result, the acceptable surgical candidate has a much older age. We review our recent experience and compare the outcomes of nonagenarians to octogenarians in lower leg ischemia.
Material(s) and Method(s):
Between 2019 and 2021 64 patients that were over the age of 80 had inteventions. Of these, 21 were nonagenarians and 43 were. Univariate and survival analysis comparing the age groups was preformed. An exact regression model with the dependent variable defined as death within a year after angioplasty and the following covariates; age over ninety, amputation, antiplatelet use and gender, was conducted.
There were 18 (86%) nonagenarians and 36 (84%) octogenarians were intervened for chronic limb ischemia (p=1.000). All the patients had lower leg angiograms (p=1.000), however 5 nanogenarians had amputations (24%) and 11 octagenerians (26%) p=0.878 had amputations. The older group had a lower use of antiplatelets (76% vs. 88%, p=0.208) but a similar rate of. anticoagulation (43% vs. 40%, p=0.788). The rate of death within a year was insignificantly different between the groups (33% vs. 23%, p=0.391) for the older and younger group respectively. Kaplan Meier analysis similarly failed to show a difference (21 vs.. 28 months, p=0.324). Exact regression revealed being a nanogenarian (p=0.6842) or other covariates was not predictive of death in a year. In fact median length of stay was trending for shorter stay for the older group 23 vs. 34 days (p=0.97).
Our study illustrate that the outcomes for nonagenarians were comparable to octogenarians. We found that the stay tended to be shorter for the older group and that maybe due a selection bias where relatively healthier patients maybe surviving to an older age.