Saarinen E, Vuorisalo S, Kauhanen P, Albäck A, Venermo M
Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Finland.
Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Finland.
Eur J Vasc Endovasc Surg. 2015 Apr;49(4):420-5. doi: 10.1016/j.ejvs.2014.12.027. Epub 2015 Feb 16.
OBJECTIVE/BACKGROUND: Owing to the increased life expectancy of the population the number of very old patients referred to vascular surgical units has increased. Advanced age is a well known risk factor in patients undergoing surgical interventions for lower limb ischemia. However, amputation performed on an elderly person living independently will lead to permanent institutional care. The aim of this study was to evaluate the outcome of patients aged 90 years and older with lower limb ischemia undergoing surgical or endovascular revascularization.
Two hundred and thirty-three nonagenarians with either chronic critical limb ischemia (CLI) or acute limb ischemia (ALI) who underwent revascularization at the authors' institution between 2002 and 2013 were included in this retrospective study. Risk factors were evaluated and survival, limb salvage, and amputation free survival (AFS) assessed.
The median age of the study population was 92 years (range 90-100 years). The majority (81.1%) of the patients were female. One in four (24.5%) patients had diabetes, and the incidence of coronary artery disease was 79.8%. Seventy-three percent of the patients had CLI and 27% of had ALI. Seventy percent of the patients underwent surgical revascularization and 30% were treated endovascularly. The majority (72.5%) of the patients maintained their independent living status; 27.5% ended up in institutional care post-operatively. Similarly, the majority (82.0%) of the patients maintained their walking ability, while 18% were not able to ambulate independently after revascularization. One year survival, limb salvage, and AFS rates were 50.9% versus 48.6% (p = .505), 85.1% versus 87.0% (p = .259), and 45.7% versus 44.4% (p = .309) in the surgical versus endovascular group, respectively. Dementia was an independent risk factor of poor AFS (odds ratio: 1.56; 95% confidence interval: 1.077-2.272; p = .019).
Good limb salvage can be achieved by both surgical and endovascular revascularization, and independent living can be maintained in the majority of the patients. However, the benefit of revascularization is limited owing to high mortality, especially in patients with dementia.
目的/背景：由于人口预期寿命的增加，转诊至血管外科的高龄患者数量有所上升。高龄是下肢缺血患者接受外科手术干预时一个众所周知的风险因素。然而，对独立生活的老年人进行截肢会导致其永久性入住机构护理。本研究的目的是评估90岁及以上下肢缺血患者接受外科或血管腔内血运重建的结果。
本回顾性研究纳入了2002年至2013年间在作者所在机构接受血运重建的233例患有慢性严重肢体缺血（CLI）或急性肢体缺血（ALI）的九旬老人。评估了风险因素，并对生存、肢体挽救和无截肢生存（AFS）情况进行了评估。
研究人群的中位年龄为92岁（范围90 - 100岁）。大多数患者（81.1%）为女性。四分之一（24.5%）的患者患有糖尿病，冠状动脉疾病的发生率为79.8%。73%的患者患有CLI，27%患有ALI。70%的患者接受了外科血运重建，30%接受了血管腔内治疗。大多数患者（72.5%）维持了独立生活状态；27.5%在术后最终入住机构护理。同样，大多数患者（82.0%）维持了行走能力，而18%在血运重建后无法独立行走。外科组与血管腔内组的1年生存率、肢体挽救率和AFS率分别为50.9%对48.6%（p = 0.505）、85.1%对87.0%（p = 0.259）和45.7%对44.4%（p = 0.309）。痴呆是AFS不良的独立危险因素（比值比：1.56；95%置信区间：1.077 - 2.272；p = 0.019）。
外科和血管腔内血运重建均可实现良好的肢体挽救，且大多数患者可维持独立生活。然而，由于高死亡率，尤其是痴呆患者，血运重建的获益有限。
