Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT.
Department of Surgery, Yale School of Medicine, New Haven, CT; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT.
Ann Vasc Surg. 2021 Apr;72:517-528. doi: 10.1016/j.avsg.2020.08.135. Epub 2020 Sep 12.
Patients with chronic limb-threatening ischemia (CLTI) at the extremes of age are thought to have distinct risk factor profiles and poor outcomes after lower extremity revascularization (LER). The aim of this study is to examine the relationships among age, risk factor profiles, and outcomes of LER in patients with CLTI in a large database focusing on the extreme age groups.
Patients undergoing LER for CLTI in the Vascular Quality Initiative suprainguinal bypass, infrainguinal bypass, and peripheral vascular intervention files were reviewed through 2019. Patients were stratified into 3 groups: premature peripheral artery disease (PAD) (≤50 years old), 51-84 years old, and elderly (≥85 years old). Trends in major amputation and mortality by age group were analyzed.
There were 156,513 patients who underwent LER for CLTI. Of these, 9,063 (5.79%) patients had premature PAD, 131,694 (84.14%) patients were 51-84 years old, and 15,756 (10.07%) were elderly. Patients with premature PAD were more likely to have insulin-dependent diabetes, be dialysis-dependent, and be active smokers compared to patients 51-84 years old and the elderly. Elderly patients were more likely to undergo an endovascular procedure for tissue loss compared to younger groups. Perioperative and 1-year major amputation rates were highest among patients with premature PAD and decreased with increasing age (P < 0.001), while perioperative and 1-year mortality increased with age (P < 0.001). On multivariable analysis, premature PAD was associated with an increased risk of major amputation (odds ratio, OR = 1.41 [1.22-1.62]), while elderly age was associated with decreased odds of major amputation compared to patients 51-84 years old (OR = 0.61 [0.51-0.73]).
Patients at the extremes of age have significantly different outcomes after LER for CLTI. Although mortality increases with age, the risk of major amputation decreases. Patients with premature PAD constitute a group of patients with a high risk of perioperative and 1-year major amputation.
患有慢性肢体威胁性缺血 (CLTI) 的高龄患者被认为具有独特的风险因素特征，并且在下肢血运重建 (LER) 后预后较差。本研究的目的是在一个专注于极端年龄组的大型数据库中检查 CLTI 患者的年龄、风险因素特征与 LER 结果之间的关系。
通过 2019 年，对血管质量倡议腹主动脉旁路术、股动脉旁路术和外周血管介入文件中接受 LER 治疗 CLTI 的患者进行了回顾。患者分为 3 组：早发性外周动脉疾病 (PAD) (≤50 岁)、51-84 岁和老年 (≥85 岁)。分析按年龄组划分的主要截肢和死亡率趋势。
共有 156513 名患者接受了 LER 治疗 CLTI。其中，9063 名 (5.79%)患者为早发性 PAD，131694 名 (84.14%)患者为 51-84 岁，15756 名 (10.07%)为老年患者。与 51-84 岁和老年患者相比，早发性 PAD 患者更可能患有胰岛素依赖型糖尿病、依赖透析和活跃吸烟者。与年轻组相比，老年患者更有可能因组织丧失而行血管内治疗。围手术期和 1 年主要截肢率在早发性 PAD 患者中最高，且随年龄增长而降低 (P<0.001)，而围手术期和 1 年死亡率随年龄增长而增加 (P<0.001)。多变量分析显示，早发性 PAD 与主要截肢风险增加相关 (比值比，OR=1.41 [1.22-1.62])，而与 51-84 岁患者相比，高龄与主要截肢风险降低相关 (OR=0.61 [0.51-0.73])。
在接受 LER 治疗 CLTI 的高龄患者中，其结果存在显著差异。尽管死亡率随年龄增长而增加，但主要截肢的风险降低。早发性 PAD 患者构成了一个围手术期和 1 年主要截肢风险较高的患者群体。
