Life Expectancy in Nonagenarians Suffering from Critical Limb Ischemia

Faber, Matthijs J.; Raats, Jelle W; Mulder, Paul; Laan, Lijckle van der

doi:10.1016/j.avsg.2016.04.012

Cited by 7 publications

(4 citation statements)

References 19 publications

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“…In this review, five studies mentioned clinical outcomes after conservative treatment, reporting inconsistent results. 10,19,24,28,30 In a recent study by Santema et al, the authors concluded that revascularisation was not required in all patients with CLTI, because of similar overall survival and AFS rates found in their study. 35 However, differences between octogenarians and non-octogenarians were not analysed.…”

Section: Discussionmentioning

confidence: 93%

“…Six studies investigated endovascular revascularisation only, 16,21,23,26,29,32 six studies investigated surgical revascularisation only, 17,20,27,28,31,34 and nine analysed both techniques. 10,15,18,19,22,24,25,30,33 In addition, in five studies a subgroup of patients was treated conservatively and four studies investigated outcomes after primary amputation as well. 10,19,24,28,30 The number of participants ranged from 36 to 10 617 patients.…”

Section: Study Characteristics and Patient Demographicsmentioning

confidence: 99%

“…10,15,18,19,22,24,25,30,33 In addition, in five studies a subgroup of patients was treated conservatively and four studies investigated outcomes after primary amputation as well. 10,19,24,28,30 The number of participants ranged from 36 to 10 617 patients. The octogenarian group sizes ranged from 19 to 4629 patients.…”

Section: Study Characteristics and Patient Demographicsmentioning

confidence: 99%

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Editor's Choice – Mortality and Major Amputation after Revascularisation in Octogenarians Versus Non-Octogenarians with Chronic Limb Threatening Ischaemia: A Systematic Review and Meta-Analysis

Wübbeke

Naves

Daemen

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS This systematic review and meta-analysis of more than 17 000 patients with chronic limb threatening ischaemia (CLTI) found an important one year mortality rate of 32% in octogenarians after revascularisation, which was significantly higher than in non-octogenarians. This outcome is of major importance to clinical practice to inform patients and colleagues adequately during the decision making process on any intervention in this fragile patient group. Objective: The aim of this systematic review and meta-analysis was to assess the clinical outcomes after revascularisation in octogenarians with chronic limb threatening ischaemia (CLTI). Methods: This was a systematic review and meta-analysis, in which the Medline, Embase, and Cochrane Library databases were searched systematically by two independent researchers. Meta-analyses were performed to analyse one year mortality, one year major amputation, and one year amputation free survival (AFS) after revascularisation. Pooled outcome estimates were reported as percentages and odds ratio (OR) with 95% confidence intervals (CI). In addition, sensitivity and subgroup analyses were performed and the quality of evidence was determined according to the GRADE system. Results: The review includes 21 observational studies with patients who were treated for CLTI. Meta-analysis of 12 studies with a total of 17 118 patients was performed. A mortality rate of 32% was found in octogenarians (95% CI 27e37%), which was significantly higher than in the non-octogenarians (17%, 95% CI 11e22%/OR 2.52, 95% CI 1.93e3.29; GRADE: "low"). No significant difference in amputation rate was found (octogenarians 15%, 95% CI 11e18%; non-octogenarians 12%, 95% CI 7e14%; GRADE: "very low"). AFS was significantly lower in the octogenarian group (OR 1.55, 95% CI 1.03e2.43; GRADE: "very low"). In a subgroup analysis differentiating between endovascular and surgical revascularisation, amputation rates were comparable. For octogenarians, those treated conservatively had a mortality rate significantly higher than those treated by revascularisation (OR 1.76, 95% CI 1.19e2.60; GRADE: "very low"). No significant difference in mortality rate was found between primary amputation and revascularisation in octogenarians (OR 0.70, 95% CI 0.24e2.03; GRADE: "very low"). Conclusion: In octogenarians with CLTI, a substantial one year mortality rate of 32% was found after revascularisation. The amputation rates were comparable between both age groups. However, only low quality evidence could be obtained supporting the results of this meta-analysis because only observational studies were available for inclusion.

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Section: Discussionmentioning

confidence: 93%

Section: Study Characteristics and Patient Demographicsmentioning

confidence: 99%

Section: Study Characteristics and Patient Demographicsmentioning

confidence: 99%

See 1 more Smart Citation

Editor's Choice – Mortality and Major Amputation after Revascularisation in Octogenarians Versus Non-Octogenarians with Chronic Limb Threatening Ischaemia: A Systematic Review and Meta-Analysis

Wübbeke

Naves

Daemen

et al. 2020

European Journal of Vascular and Endovascular Surgery

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“…This may have led to an increase in nonagenarian patients seeking attention for CLTI, a trend that is consistent with our results. To date, however, few studies have analyzed CLTI at these extreme ages [9, 10, 13, 14]. In addition, most of them have failed to present a full picture of the problem since only revascularized patients were included.…”

Section: Discussionmentioning

confidence: 99%

Critical Limb Ischemia in Nonagenarians: A Challenge of Our Times

et al. 2022

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Background As a result of the increasing life expectancy of the western population, the number of older patients with chronic limb-threatening ischemia (CLTI) seeking medical care is growing. Our objective was to describe the characteristics of a consecutive series of nonagenarian patients with CLTI and evaluate the outcomes of their management. Materials and methods Retrospective analysis of a consecutive series of nonagenarian patients with CLTI attended at our institution between 2005 and 2019. Primary endpoints were 1-year limb salvage and survival rates. Results A total of 171 patients were included (mean age 92.7, 51.5% women), of which in 59 (34.5%) primary major amputation (n = 10) or palliative care (n = 49) was indicated at presentation because of severe dementia (n = 30, 50.8%), knee retraction (n = 17, 28.8%), terminal condition (n = 13, 22%) or a non-salvageable foot (n = 28, 47.4%). In the remaining 112 (65.5%), the need for a revascularization was further assessed finally performing A) conservative treatment/minor amputation (n = 57, 50.9%), B) revascularization (n = 50, 44.6%) or C) direct major amputation (n = 5, 4.4%), with 1-year limb salvage and survival rates of 93.1 and 57.4%, respectively. Predictive factors for lower survival included age [92 years (HR = 1,59, p = 0.041), hemoglobin \10.5 mg/dL (HR 2,34, p \ 0.001), congestive heart failure (HR = 1.65, p = 0.036), non-severe dementia (HR 3,11, p \ 0.001) and current mobility with wheelchair (HR 1,74, p = 0.014). Conclusion Nearly one-third of nonagenarian patients with CLTI have a direct indication for amputation or palliative care at presentation. In the remaining, a judicious approach with conservative treatment, minor amputation or revascularization procedures yields excellent limb salvage rates. Survival is, however, the cornerstone of these patients. It can be predicted with certain clinical factors which may help decision-making.

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