Department of Vascular Surgery, Maastricht University Medical Centre, the Netherlands.
Department of Vascular Surgery, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands.
Eur J Vasc Endovasc Surg. 2020 Aug;60(2):231-241. doi: 10.1016/j.ejvs.2020.04.027. Epub 2020 Jul 21.
The aim of this systematic review and meta-analysis was to assess the clinical outcomes after revascularisation in octogenarians with chronic limb threatening ischaemia (CLTI).
This was a systematic review and meta-analysis, in which the Medline, Embase, and Cochrane Library databases were searched systematically by two independent researchers. Meta-analyses were performed to analyse one year mortality, one year major amputation, and one year amputation free survival (AFS) after revascularisation. Pooled outcome estimates were reported as percentages and odds ratio (OR) with 95% confidence intervals (CI). In addition, sensitivity and subgroup analyses were performed and the quality of evidence was determined according to the GRADE system.
The review includes 21 observational studies with patients who were treated for CLTI. Meta-analysis of 12 studies with a total of 17 118 patients was performed. A mortality rate of 32% was found in octogenarians (95% CI 27-37%), which was significantly higher than in the non-octogenarians (17%, 95% CI 11-22%/OR 2.52, 95% CI 1.93-3.29; GRADE: "low"). No significant difference in amputation rate was found (octogenarians 15%, 95% CI 11-18%; non-octogenarians 12%, 95% CI 7-14%; GRADE: "very low"). AFS was significantly lower in the octogenarian group (OR 1.55, 95% CI 1.03-2.43; GRADE: "very low"). In a subgroup analysis differentiating between endovascular and surgical revascularisation, amputation rates were comparable. For octogenarians, those treated conservatively had a mortality rate significantly higher than those treated by revascularisation (OR 1.76, 95% CI 1.19-2.60; GRADE: "very low"). No significant difference in mortality rate was found between primary amputation and revascularisation in octogenarians (OR 0.70, 95% CI 0.24-2.03; GRADE: "very low").
In octogenarians with CLTI, a substantial one year mortality rate of 32% was found after revascularisation. The amputation rates were comparable between both age groups. However, only low quality evidence could be obtained supporting the results of this meta-analysis because only observational studies were available for inclusion.
本系统评价和荟萃分析旨在评估患有慢性肢体威胁性缺血（CLTI）的 80 岁以上患者血管重建后的临床结局。
这是一项系统评价和荟萃分析，两名独立研究员系统地检索了 Medline、Embase 和 Cochrane 图书馆数据库。进行荟萃分析以分析血管重建后一年的死亡率、一年主要截肢率和一年无截肢生存率（AFS）。汇总的结果估计以百分比和比值比（OR）以及 95%置信区间（CI）报告。此外，还进行了敏感性和亚组分析，并根据 GRADE 系统确定证据质量。
本综述纳入了 21 项针对 CLTI 患者的观察性研究。对 12 项共纳入 17118 例患者的研究进行了荟萃分析。发现 80 岁以上患者的死亡率为 32%（95%CI 27-37%），明显高于非 80 岁以上患者（17%，95%CI 11-22%/OR 2.52，95%CI 1.93-3.29；GRADE：“低”）。截肢率无显著差异（80 岁以上患者 15%，95%CI 11-18%；非 80 岁以上患者 12%，95%CI 7-14%；GRADE：“非常低”）。80 岁以上患者的 AFS 明显较低（OR 1.55，95%CI 1.03-2.43；GRADE：“非常低”）。在区分血管内和手术血管重建的亚组分析中，截肢率相当。对于保守治疗的 80 岁以上患者，死亡率明显高于血管重建治疗的患者（OR 1.76，95%CI 1.19-2.60；GRADE：“非常低”）。在 80 岁以上患者中，初次截肢与血管重建的死亡率无显著差异（OR 0.70，95%CI 0.24-2.03；GRADE：“非常低”）。
在患有 CLTI 的 80 岁以上患者中，血管重建后一年的死亡率为 32%，这是一个相当大的比例。两个年龄组的截肢率相当。然而，由于仅可获得观察性研究，因此只能获得支持这项荟萃分析结果的低质量证据。
