Department of Surgery, Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands.
World J Surg. 2012 Dec;36(12):2937-43. doi: 10.1007/s00268-012-1758-y.
Critical limb ischemia (CLI) has a poor outcome when left untreated. The benefits of revascularization in the very elderly might be limited because of co-morbidities and short life expectancy. Therefore, optimal management of CLI in the elderly is not straightforward. We analyzed treatment results for elderly patients with CLI (Rutherford 4 or 5/6) in our clinic.
Hospital charts of all patients>70 years of age diagnosed with Rutherford stage 4-6 peripheral arterial disease between January 2006 and December 2009 were reviewed. We divided patients into two age groups (70-79 and ≥80 years) to compare treatment results. Primary interventions were defined as conservative, endovascular, reconstructive surgery, and amputation. Outcome measures were mortality, reintervention, and major amputation rates.
There were 191 patients [99 (52%) were women], median age 78.4 years, range 70-98 years. Altogether, 119 (62%) patients were aged 70-79 years, and 72 (38%) were ≥80 years. The primary intervention was equally divided over the two age groups (p=0.21). Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease (TASC II) classifications of aortoiliac lesions were not significantly different regarding intervention (p=0.62) or age (p=0.39). TASC II classification of femoropopliteal lesions was significantly different relative to intervention (p<0.01) but not different between age groups (p=0.68). Mortality rate after reconstructive surgery was significant higher in the oldest age group (p<0.01). After conservative treatment, endovascular treatment, or amputation, the mortality rates were not significantly different between the two age groups (respectively, p=0.06, p=0.33, p=0.76). Reintervention rate was 51% in the 70- to 79-year group compared to 32% in the ≥80-year group. After initial treatment, major amputations were performed in 10% in the 70- to 79-year group compared to 13% in the ≥80-year group.
In patients aged≥80 years, surgical revascularization resulted in a significant higher mortality rate in our clinic, whereas primary conservative, endovascular treatment and amputation resulted in similar mortality in both age groups. When considering surgical revascularization in the very elderly, surgeons should focus on careful patient selection.
未治疗的严重肢体缺血（CLI）预后不良。由于合并症和预期寿命短，非常老年患者的血运重建获益可能有限。因此，老年人 CLI 的最佳治疗并不简单。我们分析了我院 CLI（Rutherford 4 或 5/6）老年患者的治疗结果。
回顾 2006 年 1 月至 2009 年 12 月期间诊断为 Rutherford 4-6 期外周动脉疾病的所有>70 岁患者的住院病历。我们将患者分为两个年龄组（70-79 岁和≥80 岁）以比较治疗结果。主要干预措施定义为保守治疗、血管内治疗、重建手术和截肢。主要终点为死亡率、再干预和大截肢率。
共 191 例患者（99 例[52%]为女性），中位年龄 78.4 岁，范围 70-98 岁。共有 119 例（62%）患者年龄在 70-79 岁，72 例（38%）患者年龄≥80 岁。两个年龄组的主要干预措施基本相同（p=0.21）。在 TASC II 分类的腹主动脉髂动脉病变方面，干预方式（p=0.62）和年龄（p=0.39）无显著差异。在 TASC II 分类的股腘动脉病变方面，干预方式差异显著（p<0.01），但年龄组间无差异（p=0.68）。在最年长的年龄组中，重建手术后的死亡率明显更高（p<0.01）。在保守治疗、血管内治疗或截肢后，两个年龄组的死亡率无显著差异（分别为 p=0.06、p=0.33、p=0.76）。70-79 岁组的再干预率为 51%，而≥80 岁组为 32%。初始治疗后，70-79 岁组有 10%的患者进行了大截肢，而≥80 岁组有 13%的患者进行了大截肢。
在我院，≥80 岁的患者行手术血运重建后死亡率明显更高，而保守、血管内治疗和截肢治疗在两个年龄组中的死亡率相似。在考虑对非常老年患者进行手术血运重建时，外科医生应注重仔细选择患者。
