Outcomes After Endovascular Revascularization in Octogenarians and Non-Octogenarians With Critical Limb Ischemia

Abstract

Purpose: To determine the outcome and periprocedural risk of endovascular revascularization in octogenarians with critical limb ischemia (CLI) compared with their younger counterparts. Methods: The multicenter, prospective registry for First-line Treatments in Patients With Critical Limb Ischemia (CRITISCH) enrolled 642 patients treated with endovascular techniques ( ClinicalTrials.gov identifier NCT01877252). The patients were dichotomized according to age <80 years (n=421; mean age 69 years, 292 men; group 1) or ≥80 years (n=221; mean age 85 years, 113 men; group 2). The groups had similar distributions in Rutherford categories 4 to 6, but group 1 had more men, smokers, diabetics, and patients on dialysis. The primary composite endpoint of the study was amputation and/or death. Key secondary endpoints were in-hospital mortality and major amputation, as well as major adverse limb events (MALE; any reintervention or major amputation involving the index limb) at 1 year. Results: The in-hospital mortality was 1% in group 1 and 2% in group 2 (p=0.204) and the major amputation rates were 4% and 2% (p=0.169), respectively. Amputation-free survival at 1 year was 75% in group 1 and 77% in group 2 (p=0.340), whereas freedom from MALE was significantly different between the groups [62% group 1 vs 72% group 2; hazard ratio (HR) 1.45, 95% confidence interval (CI) 1.09 to 1.93, p=0.016). Limb salvage was 90% in group 1 and 95% in group 2 (HR 2.16, 95% CI 1.27 to 3.69, p=0.01). Conclusion: Octogenarians with CLI treated by endovascular means showed comparable early and 1-year amputation-free survival rates vs their younger counterparts, and limb salvage and freedom from MALE rates were even higher in octogenarians.