Ormaechevarria Amaia, Vega de Céniga Melina, Blanco June, Yáñez Laura, Fernández June, Estallo Luis
Department of Angiology and Vascular Surgery, Galdakao-Usansolo University Hospital, Bizkaia, Spain.
EJVES Vasc Forum. 2024 Jan 3;61:36-42. doi: 10.1016/j.ejvsvf.2023.12.003. eCollection 2024.
A growing proportion of patients with chronic limb threatening ischaemia (CLTI) are elderly, the most challenging for management decisions. The aim was to study the patient profile and outcome of CLTI in octogenarian patients, comparing them with younger patients.
Retrospective cohort of consecutive patients hospitalised for CLTI with infrainguinal disease in a Spanish centre (2013-2020). Data on age, comorbidity, anatomical characteristics, and treatment were gathered. Patients were stratified according to age (<80 and ≥80 years). The primary outcomes were overall survival and limb salvage (LS), analysed using Kaplan-Meier and Cox regression.
: A total of 512 patients were enrolled: 305 were <80 years old with mean age 69.7 ± standard deviation (SD) 8.2 years, and 207 were ≥80 years old with mean age 85.3 ± SD 3.6 years. Smoking and diabetes mellitus were more frequent in younger patients (78.0% . 45.4%, < .001; 68.5% 59.5%, = .037 respectively). Older patients had a higher prevalence of heart and kidney disease (70.5% vs. 57.0%, = .002; 39.6% 24.3%, < .001, respectively). The arterial disease was femoropopliteal or tibial in 68.9% and 31.1% in patients <80 years and 58.9% and 41.1% in patients ≥80 years ( = .021). In younger patients, conservative treatment was indicated in 18.0%, endovascular treatment (ET) in 41.6%, and open or hybrid surgery (OS) in 40.3%; in patients ≥80 years these were 36.9%, 37.4%, and 25.7%, respectively ( <. 001). Mean follow up was 23.3 ± SD 17.4 months. One and two year overall survival was 85.4% and 73.0% in younger patients and 64.1% and 51.3% in patients ≥80 years ( < .001). LS was 83.7% and 79% at the same times in younger patients and 75.3% and 72.1% in older ones ( = .045). In younger patients ET led to worse LS than OS ( = .005) but not in older patients ( = .29).
Patients ≥80 years with CLTI have higher comorbidity and lower life expectancy and receive conservative treatment more frequently than younger patients. ET and OS are associated with similar survival and LS in these older patients.
在慢性肢体威胁性缺血（CLTI）患者中，老年患者的比例日益增加，这给治疗决策带来了极大挑战。本研究旨在探讨八旬CLTI患者的特征及预后，并与年轻患者进行比较。
对西班牙某中心（2013 - 2020年）因CLTI伴股腘以下病变而连续住院的患者进行回顾性队列研究。收集患者的年龄、合并症、解剖特征及治疗等数据。根据年龄将患者分为两组（<80岁和≥80岁）。主要结局指标为总生存率和肢体挽救率（LS），采用Kaplan-Meier法和Cox回归分析。
共纳入512例患者：305例年龄<80岁，平均年龄69.7±标准差（SD）8.2岁；207例年龄≥80岁，平均年龄85.3±SD 3.6岁。年轻患者中吸烟和糖尿病更为常见（分别为78.0%对45.4%，P<0.001；68.5%对59.5%，P = 0.037）。老年患者中心脏病和肾病的患病率更高（分别为70.5%对57.0%，P = 0.002；39.6%对24.3%，P<0.001）。年龄<80岁患者中，股腘动脉病变和胫动脉病变分别占68.9%和31.1%；年龄≥80岁患者中，上述比例分别为58.9%和41.1%（P = 0.021）。年轻患者中，18.0%接受保守治疗，41.6%接受血管内治疗（ET），40.3%接受开放或杂交手术（OS）；年龄≥80岁患者中，上述比例分别为36.9%、37.4%和25.7%（P<0.001）。平均随访时间为23.3±SD 17.4个月。年龄<80岁患者1年和2年总生存率分别为85.4%和73.0%，年龄≥80岁患者分别为64.1%和51.3%（P<0.001）。同期年轻患者LS分别为83.7%和79%，老年患者分别为75.3%和72.1%（P = 0.045）。在年轻患者中，ET导致的LS比OS差（P = 0.005），但在老年患者中并非如此（P = 0.29）。
年龄≥80岁的CLTI患者合并症更多，预期寿命更低，且比年轻患者更常接受保守治疗。在这些老年患者中，ET和OS的生存率和LS相似。
