Vascular Surgery Section, Geriatric Surgery Clinic, Department of Surgical and Gastroenterological Sciences, University of Padua, Padova, Italy.
Surgery. 2010 Jul;148(1):119-28. doi: 10.1016/j.surg.2009.12.013. Epub 2010 Feb 10.
Although numerous studies have addressed peripheral revascularizations for critical limb ischemia (CLI) in patients aged > or =80 years, few have focused exclusively on infrapopliteal arterial reconstructions. This study aimed to analyze early and long-term outcomes in very elderly patients who underwent surgical infrapopliteal revascularization for CLI according to their pre-operative ambulatory function and residential status.
Over an 18-year period, all consecutive patients aged > or =80 years referred to our institution for CLI requiring primary infrapopliteal or inframalleolar arterial reconstruction were enrolled in the study. All procedures were completed by the same surgeon with patients under regional anesthesia. Patency, limb salvage, amputation-free survival, and cumulative survival rates were assessed by Kaplan-Meier analysis. The patient's pre- and postoperative ambulatory function and residential status (at home vs in a nursing home) were also analyzed. The mean follow-up was 6.2 years (range, 0.1-11.5) and was obtained for 98% of patients.
In all, 197 patients (134 men; mean +/- SD age, 82.8 +/- 1.7 years) with 201 critically ischemic limbs were enrolled in the study. No deaths or fatal major complications occurred in the peri-operative period (first 30 days); the local complication rate was 6%. After 1 and 7 years, the primary patency rates were 88% and 68%, the limb salvage rates were 96% and 87%, the amputation-free survival rates were 88% and 39%, and the survival rates were 91% and 44%, respectively. At last follow-up or death, 80% of the patients were ambulatory and 20% were not; 80% lived at home and were independent, another 9% lived at home with assistance, and 76% of the sample lived at home and were ambulatory.
Infrapopliteal arterial revascularization in the very elderly with CLI proved safe, effective, and durable, confirming that age per se and concomitant comorbidities do not necessarily affect technical and clinical outcomes. Ambulatory function and independent living status are well preserved because, despite a relatively short life expectancy, the majority of very elderly revascularized CLI patients can be expected to spend their remaining years ambulatory and at home. In contrast, patients with poor ambulatory function or who required assistance pre-operatively were less likely to improve their status after limb revascularization despite a successful technical result.
虽然有许多研究探讨了年龄大于或等于 80 岁的患者的肢体严重缺血（CLI）的外周血运重建，但很少有研究专门针对腘动脉以下的动脉重建。本研究旨在根据术前活动能力和居住状况，分析接受 CLI 腘动脉以下动脉重建术的非常高龄患者的早期和长期结果。
在 18 年期间，所有因 CLI 而被转诊至我院，需要进行初次腘动脉或胫后动脉重建的年龄大于或等于 80 岁的连续患者均被纳入本研究。所有手术均由同一位外科医生在局部麻醉下完成。通过 Kaplan-Meier 分析评估通畅率、肢体存活率、免于截肢的生存率和累积生存率。还分析了患者术前和术后的活动能力和居住状况（在家中或养老院）。平均随访时间为 6.2 年（范围 0.1-11.5 年），98%的患者获得了随访。
共有 197 例（134 例男性；平均年龄 82.8 ± 1.7 岁）的 201 例严重缺血肢体患者纳入本研究。围手术期（前 30 天）无死亡或致命性严重并发症；局部并发症发生率为 6%。1 年和 7 年后，原发性通畅率分别为 88%和 68%，肢体存活率分别为 96%和 87%，免于截肢的生存率分别为 88%和 39%，生存率分别为 91%和 44%。最后一次随访或死亡时，80%的患者能够活动，20%的患者不能活动；80%的患者在家中独立生活，9%的患者在家中需要帮助，76%的患者在家中且能够活动。
CLI 非常高龄患者的腘动脉以下动脉血运重建是安全、有效且持久的，证实了年龄本身和并存的合并症不一定会影响技术和临床结果。活动能力和独立生活状态得到了很好的保留，因为尽管预期寿命相对较短，但大多数接受过肢体血运重建的非常高龄 CLI 患者有望在余下的日子里能够独立行走并在家中生活。相比之下，尽管手术技术成功，但术前活动能力差或需要帮助的患者，其肢体血运重建后改善其状况的可能性较小。
