Rizzi Maria Chiara, Soenens Gilles, Pancheri Ornella, Tasselli Sebastiano, Moreels Nathalie, Van Herzeele Isabelle, Bonvini Stefano
Department of Vascular and Endovascular Surgery, APSS Trento, Trento, Rovereto, Italy.
Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
Cardiovasc Intervent Radiol. 2025 Jun 9. doi: 10.1007/s00270-025-04065-z.
The average age of patients with Chronic Limb-Threatening Ischemia (CLTI) who are being referred to vascular surgery units is increasing. This study aimed to evaluate clinical outcomes of revascularization (wound healing and cessation of rest pain) in nonagenarians with CLTI and the impact on their initial living status.
This retrospective, single centre study included patients aged 90 or more who presented with CLTI. Two groups were compared: "treated", who underwent revascularization (open, endovascular or hybrid), versus "not treated", who were treated conservatively. The latter included patients unfit for invasive treatment, with overriding active diseases, hip/knee ankylosis or refusing invasive treatment. Both groups were followed by dedicated wound care specialists. The primary outcomes were wound healing or cessation of rest pain and maintenance of initial living status after discharge. Secondary outcomes were overall mortality and major amputations at 1, 3, 6 and 12 months. Demographics, type of invasive treatment, access related complications and postoperative general complications were collected as well. Wound healing and mortality were assessed using cumulative outcome estimates according to Kaplan-Meier and comparisons using the log-rank test.
Between 1st January 2018 and 31st July 2023, 123 patients with 131 chronic limb-threatening ischemic limbs were included. The "treated" group included 101 limbs with Rutherford 4 (n = 8,7.9%), 5 (n = 78, 77.2%) and 6 (n = 15, 14.9%) Peripheral Arterial Disease (PAD),. The "not treated" group included 30 limbs with Rutherford 5 (n = 22, 73.3%) and 6 (n = 8, 26.7%) PAD. Treatment consisted of eight open, 86 endovascular and seven hybrid procedures. No primary amputations were conducted. At 1 year, 64.6% (31/48) of the wounds in the "treated" group healed, while non healed in the "not treated" group (p < .001). Eighty-nine (94%) of the treated patients lived at home, and 72/89 (81%) were able to return home after discharge. One-year mortality rates for treated and not treated patients were 31.7% and 63.3%, respectively (p < .001). Access related complications were noted in 6.9% of the nonagenarians and 33.7% had a general adverse event.
Revascularization in nonagenarians with CLTI can be effective despite the advanced age. Wound healing is feasible without compromising the initial patient living autonomy and maintaining a low risk of major amputation and an acceptable mortality rate.
转诊至血管外科的慢性肢体威胁性缺血（CLTI）患者的平均年龄在增加。本研究旨在评估CLTI非agenarians患者血管重建的临床结果（伤口愈合和静息痛停止）及其对初始生活状态的影响。
这项回顾性单中心研究纳入了90岁及以上的CLTI患者。比较了两组：“接受治疗”组，即接受血管重建（开放、血管内或杂交）的患者，与“未治疗”组，即接受保守治疗的患者。后者包括不适合侵入性治疗、患有严重活动性疾病、髋/膝关节强直或拒绝侵入性治疗的患者。两组均由专门的伤口护理专家进行随访。主要结果是伤口愈合或静息痛停止以及出院后初始生活状态的维持。次要结果是1、3、6和12个月时的总体死亡率和大截肢率。还收集了人口统计学、侵入性治疗类型、与通路相关的并发症和术后一般并发症。使用根据Kaplan-Meier的累积结果估计评估伤口愈合和死亡率，并使用对数秩检验进行比较。
在2018年1月1日至2023年7月31日期间，纳入了123例患者的131条慢性肢体威胁性缺血肢体。“接受治疗”组包括101条患有卢瑟福4级（n = 8，7.9%）、5级（n = 78，77.2%）和6级（n = 15，14.9%）外周动脉疾病（PAD）的肢体。“未治疗”组包括30条患有卢瑟福5级（n = 22，73.3%）和6级（n = 8，26.7%）PAD的肢体。治疗包括8例开放手术、86例血管内手术和7例杂交手术。未进行初次截肢。1年后，“接受治疗”组64.6%（31/48）的伤口愈合，而“未治疗”组伤口未愈合（p < 0.001）。89例（94%）接受治疗的患者在家中生活，其中72/89（81%）出院后能够回家。接受治疗和未接受治疗的患者1年死亡率分别为31.7%和63.3%（p < 0.001）。在非agenarians患者中，6.9%出现了与通路相关的并发症，33.7%发生了一般不良事件。
尽管年龄较大，但CLTI非agenarians患者的血管重建仍可能有效。伤口愈合是可行的，不会损害患者的初始生活自主性，并且保持低大截肢风险和可接受的死亡率。
