Steunenberg Stijn L, de Vries Jolanda, Raats Jelle W, Verbogt Nathalie, Lodder Paul, van Eijck Geert-Jan, Veen Eelco J, de Groot Hans G W, Ho Gwan H, der Laan Lijckle van
Department of Surgery, Amphia Hospital, Breda, the Netherlands.
Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
Vasc Endovascular Surg. 2020 Feb;54(2):126-134. doi: 10.1177/1538574419885478. Epub 2019 Nov 10.
Revascularization is the cornerstone of the treatment of critical limb ischemia (CLI), but the number of elderly frail patients increase. Revascularization is not always possible in these patients and conservative therapy seems to be an option. The goals of this study are to analyze the 1-year quality of life (QoL) results and mortality rates of elderly patients with CLI and to investigate if conservative treatment could be an acceptable treatment option.
Patients with CLI ≥70 years old were included in a prospective observational cohort study in 2 hospitals in the Netherlands between 2012 and 2016 and were divided over 3 treatment modalities: endovascular therapy, surgical revascularization, and conservative treatment. The World Health Organization Quality of Life (WHOQoL-Bref) instrument, a generic QoL assessment tool that includes components of physical, psychological, social relationships and environment, was used to evaluate QoL at baseline, 6 months, and 1 year.
In total, 195 patients (56% male, 33% Rutherford 4, mean age of 80) were included. Physical QoL significantly increased after surgical (10.4 vs 14.9, < .001), endovascular (10.9 vs 13.7, < .001), and conservative therapy (11.6 vs 13.2, = .01) at 1 year. One-year mortality was relatively low after surgery (10%) compared to endovascular (40%) and conservative therapy (37%).
The results of this study could not be used to designate the superior treatment used in elderly patients with CLI. Conservative treatment could be an acceptable treatment option in selected patients with CLI unfit for revascularization. Treatment of choice in elderly patients with CLI is based on multiple factors and should be individualized in a shared decision-making process.
血管再通是治疗严重肢体缺血（CLI）的基石，但老年体弱患者的数量在增加。在这些患者中并非总能进行血管再通，保守治疗似乎是一种选择。本研究的目的是分析老年CLI患者的1年生活质量（QoL）结果和死亡率，并调查保守治疗是否可能是一种可接受的治疗选择。
2012年至2016年期间，在荷兰的2家医院对年龄≥70岁的CLI患者进行了一项前瞻性观察队列研究，并将其分为3种治疗方式：血管内治疗、外科血管再通和保守治疗。使用世界卫生组织生活质量（WHOQoL-Bref）工具，这是一种通用的QoL评估工具，包括身体、心理、社会关系和环境等方面，在基线、6个月和1年时评估QoL。
共纳入195例患者（男性占56%，33%为卢瑟福4级，平均年龄80岁）。1年后，手术（10.4对14.9，P<.001）、血管内治疗（10.9对13.7，P<.001）和保守治疗（11.6对13.2，P=.01）后身体QoL显著提高。与血管内治疗（40%）和保守治疗（37%）相比，手术后1年死亡率相对较低（10%）。
本研究结果不能用于确定老年CLI患者的最佳治疗方法。对于某些不适合血管再通的CLI患者，保守治疗可能是一种可接受的治疗选择。老年CLI患者的治疗选择基于多种因素，应在共同决策过程中个体化。
