Department of General Surgery, Santa Barbara Cottage Hospital, Santa Barbara, CA.
Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA.
Ann Vasc Surg. 2023 Oct;96:261-267. doi: 10.1016/j.avsg.2023.03.022. Epub 2023 Apr 10.
Endovascular interventions are performed routinely with minimal risk in younger populations. The safety and efficacy of endovascular interventions in nonagenarians is under examined. We sought to examine the following (1) mortality and limb salvage rates in the nonagenarian population and (2) whether frailty was associated with outcomes following lower extremity (LE) interventions for both acute limb ischemia (ALI) and chronic limb threatening ischemia (CLTI).
A retrospective review of patients ≥90 years who underwent a LE angiogram for ALI or CLTI over a 12-year period at a single institution was performed. Primary outcomes were 30-day and 12-month limb salvage and mortality rates. Patient demographics, 30-day complications, and 12-month target vessel reintervention (TVR) were reviewed. Frailty scores were calculated using the 11-factor modified frailty index (MFI-11).
From 2009 to 2021, 76 patients (36% male) with a mean age of 93 (range: 90-102) underwent endovascular procedures for ALI (n = 13) and CLTI (n = 63). 30-day amputation and mortality rates were 6% and 8%, respectively. Patient demographics, preoperative functional status, and TVR rates were not different between patients who had early amputation (≤30 days) and those who achieved limb salvage. Seventy-two patients (94%) had follow-up data at 30 days. There was an 8% mortality rate at 30 days. Of those alive at 30 days, 94% of patients had successful limb salvage. Fifty-eight patients had complete follow-up data at 12 months. Of the patients alive at 12-month follow-up (75%), the limb salvage rate was 98%. Patients with amputation at 30 days had a significantly higher mortality rate at 12 months compared to those who did not (83% vs. 19%; P < 0.01). Based on MFI-11 scoring, 35% of the population was considered frail (≥0.27). Frail patients did not have significantly different 30-day outcomes (limb salvage: 94% vs. 88%; mortality 8% vs. 9%, P = 0.41 and 0.94, respectively) or 12-month outcomes (limb salvage: 82% vs. 94%; mortality: 32% vs. 22%, P = 0.28 and 0.39, respectively).
Endovascular procedures can be done safely in nonagenarians with low mortality and amputation rates. Patients with early amputation are at significantly higher risk of death at 12 months. Frailty, as measured by a validated index, was not associated with early or late outcomes. When compared to immediate amputation, nonagenarian patients and their families should be counseled as to the benefit from a minimally invasive endovascular procedure.
血管内介入治疗在年轻人群中常规进行，风险极小。90 岁以上人群行血管内介入治疗的安全性和有效性尚未得到充分研究。我们旨在研究以下内容：（1）90 岁以上人群的死亡率和保肢率；（2）虚弱是否与下肢（LE）急性肢体缺血（ALI）和慢性肢体威胁性缺血（CLTI）介入治疗后的结局相关。
回顾性分析了在一家单中心 12 年内接受 LE 血管造影检查的年龄≥90 岁的 ALI 或 CLTI 患者。主要结局为 30 天和 12 个月的保肢和死亡率。回顾患者的人口统计学资料、30 天并发症和 12 个月目标血管再介入（TVR）情况。使用 11 项修正虚弱指数（MFI-11）计算虚弱评分。
2009 年至 2021 年，76 名（36%为男性）患者平均年龄为 93（范围：90-102）岁，行血管内手术治疗 ALI（n=13）和 CLTI（n=63）。30 天截肢和死亡率分别为 6%和 8%。患者的人口统计学资料、术前功能状态和 TVR 率在 30 天内早期截肢（≤30 天）和保肢的患者之间没有差异。72 名（94%）患者在 30 天时有随访数据。30 天死亡率为 8%。30 天存活的患者中，94%的患者保肢成功。58 名患者在 12 个月时有完整的随访数据。12 个月时存活的患者（75%）保肢率为 98%。30 天截肢的患者 12 个月死亡率明显高于未截肢的患者（83%比 19%；P<0.01）。根据 MFI-11 评分，35%的患者被认为虚弱（≥0.27）。虚弱患者 30 天的结局没有显著差异（保肢：94%比 88%；死亡率：8%比 9%，P=0.41 和 0.94）或 12 个月的结局（保肢：82%比 94%；死亡率：32%比 22%，P=0.28 和 0.39）。
血管内介入治疗在 90 岁以上人群中是安全的，死亡率和截肢率较低。早期截肢的患者在 12 个月时死亡的风险显著增加。虚弱，通过验证指数来衡量，与早期或晚期结局无关。与立即截肢相比，90 岁以上的患者及其家属应该接受咨询，了解微创血管内手术的益处。
