Lower Extremity Arterial Reconstruction in Octogenarians and Older

Abstract

Background Despite previous single-institution studies showing that lower extremity arterial reconstruction (LEAR) in octogenarians and older may be undertaken with acceptable postoperative morbidity and mortality, there continues to be significant reluctance, in the vascular surgical community, to undertaking these complex revascularization procedures in this very elderly population. We undertook this study in an effort to determine the outcomes of LEAR in octogenarians and older on a national level. Methods The American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) Database was queried to identify all patients who underwent LEAR between January 1, 2005 and December 31, 2009. Patient demographics and presenting comorbidities were recorded, and multivariate analyses were performed to compare outcomes in patients 80 and older to that in younger patients. Results There were 19,028 patients who underwent open infrainguinal LEAR during this time period. Patients ≥ 80 comprised 18% (3,486 patients); and patients < 80 years comprised 82% (15,542 patients). Multivariate analysis demonstrated that patients ≥ 80 years of age had an increased likelihood of mortality (OR 1.79, 95% CI 1.42-2.26), cardiovascular (OR 1.46, 95% CI 1.12-1.89), respiratory (OR 1.37, 95% CI 1.12-1.67) and renal (OR 1.57, 95% CI 1.27-1.95) complications. There was, however, no significant difference in the likelihood of graft failure (OR 1.04, 95% CI 0.86-1.27), wound infection (OR 0.92, 95% CI 0.79-1.06), or major amputation (OR 0.59, 95% CI 0.13-2.74) between these two groups. Conclusion LEAR in octogenarians is associated with an increased risk of postoperative morbidity and mortality, but no increased risk of wound infection, amputation or graft failure.

Alternative vein bypass in octogenarians with chronic limb-threatening ischaemia

“…However, a retrospective data analysis of the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) showed a significantly increased likelihood of cardiovascular, renal and respiratory complications in octogenarians. In this analysis all patients undergoing lower extremity arterial reconstruction between 2005 and 2009 independent of the extent of the revascularization or the graft type were included 23 . These conflicting results compared with the current data might have been caused by the aforementioned selection bias.…”

2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

“…In retrospective cohorts of patients with PAD, morbidity, functional status, prescription of GDMT, and overall mortality were significantly worse after revascularization procedures and major amputation in elderly patients when compared with younger patients with PAD. 14,15,20,21 Identification of these geriatric syndromes in older adults with PAD can be a catalyst for shared decision-making to evaluate the use of endovascular, surgical, or hybrid revascularization procedures to balance the risk of complications or loss of independence against the potential for improved QOL and palliation of symptoms with a limited life span.…”

Peripheral Artery Disease

“…For patients with life-limiting claudication and CLTI, percutaneous transluminal angioplasty and stents, as well as peripheral artery surgery, should be considered (Schillinger and Minar 2012). However, lower extremity arterial reconstruction in octogenarians and older patients is associated with an increased risk of postoperative mortality, as well as increased cardiovascular, respiratory, and renal complications (Hamdi et al 2016).…”