Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Hospitals and Health Center, Ann Arbor, Michigan, USA.
JACC Cardiovasc Interv. 2011 Jun;4(6):694-701. doi: 10.1016/j.jcin.2011.03.012.
This study sought to evaluate the effect of age on procedure type, periprocedural management, and in-hospital outcomes of patients undergoing lower-extremity (LE) peripheral vascular intervention (PVI).
Surgical therapy of peripheral arterial disease is associated with significant morbidity and mortality in the elderly. There are limited data related to the influence of advanced age on the outcome of patients undergoing percutaneous LE PVI.
Clinical presentation, comorbidities, and in-hospital outcomes of patients undergoing LE PVI in a multicenter, multidisciplinary registry were compared between 3 age groups: < 70 years, between 70 and 80 years, and ≥ 80 years (elderly group).
In our cohort, 7,769 patients underwent LE PVI. The elderly patients were more likely to be female and to have a greater burden of comorbidities. Procedural success was lower in the elderly group (74.2% for age ≥ 80 years vs. 78% for age 70 to < 80 years and 81.4% in patients age < 70 years, respectively; p < 0.0001). Unadjusted rates of procedure-related vascular access complications, post-procedure transfusion, contrast-induced nephropathy, amputation, and major adverse cardiac events were higher in elderly patients. After adjustment for baseline covariates, the elderly patients were more likely to experience vascular access complications; however, advanced age was not found to be associated with major adverse cardiac events, transfusion, contrast-induced nephropathy, or amputation.
Contemporary PVI can be performed in elderly patients with high procedural and technical success with low rates of periprocedural complications including mortality. These findings may support the notion of using PVI as a preferred revascularization strategy in the treatment of severe peripheral arterial disease in the elderly population.
本研究旨在评估年龄对下肢（LE）外周血管介入（PVI）患者的手术类型、围手术期管理和住院结局的影响。
老年人的外周动脉疾病手术治疗与显著的发病率和死亡率相关。关于高龄对接受经皮 LE PVI 患者结局的影响，相关数据有限。
对多中心、多学科注册登记处接受 LE PVI 的患者的临床表现、合并症和住院结局，在 3 个年龄组（<70 岁、70-80 岁和≥80 岁[老年组]）之间进行了比较。
在我们的队列中，7769 例患者接受了 LE PVI。老年患者更可能为女性，且合并症负担更大。老年组的手术成功率较低（年龄≥80 岁组为 74.2%，年龄 70-<80 岁组为 78%，年龄<70 岁组为 81.4%；p<0.0001）。未校正的血管通路并发症、术后输血、造影剂肾病、截肢和主要不良心脏事件的发生率在老年患者中更高。在校正了基线协变量后，老年患者更有可能发生血管通路并发症；但高龄与主要不良心脏事件、输血、造影剂肾病或截肢无关。
目前，在高龄患者中进行 PVI 可以实现较高的手术和技术成功率，且围手术期并发症发生率低，包括死亡率。这些发现可能支持将 PVI 作为治疗老年人群严重外周动脉疾病的首选血运重建策略的观点。
