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Home > Vascular Annual Meeting > pvss14_hnath_lower

PVSS14. Is Lower Extremityrevascularization Safe in Nonagenarians?

Jeffrey Hnath, Sean P. Roddy, R. Clement Darling, III, Paul B. Kreienberg, Benjamin B. Chang, Kathleen J. Ozsvath, Philip S.K. Paty, Yaron Sternbach, John B. Taggert, Manish Mehta.
Albany Medical College, Albany, N.Y.

OBJECTIVES: The average lifespan in the US continues to lengthen leading to an increased number of nonagenarians presenting with critical limb ischemia. The objective of this study is to evaluate the outcomes of lower extremity revascularization in patients older than 90 years of age.

METHODS: The vascular registry at our institution was retrospectively reviewed for all lower extremity bypasses performed between 1996 and 2006. We evaluated patient demographics, indications, procedure, patency rates, and complications. Patients were divided into groups based on age greater than 90 years of age (>90) and less than or equal to 90 years of age (<90). Variables were evaluated by Chi square analysis. Outcomes were prepared using life table methods and compared through log rank analysis.

RESULTS: Over the last 10 years, 5443 lower extremity bypasses were performed on the <90 and 150 on the >90 groups. The <90 group had significantly more males (61.4% vs. 29.3%) and was obviously younger (68 years; range 7-89 vs. 92 years; 90-101) than the >90 group. The <90 group had more comorbidities in terms of diabetes, active tobacco use, and hypercholesterolemia. There was no significant difference in coronary artery disease or chronic renal insufficiency between the groups. Critical limb ischemia as an indication was significantly higher in the >90 group (149, 99% vs. 4472, 82%; p<0.05). Strikingly, the primary patency rate was higher in the >90 group at 4 years (77% vs. 62%; p<0.05). However, secondary patency did not differ. Complications were similar between the groups except for a higher rate of late occlusion (824, 15% vs. 11, 7%; p<0.05) in the <90 group. The amputation rates did not differ between the groups. (<90, 3.3% vs. >90, 1.3%; p<0.05). The perioperative (15% vs. 3%; p<0.05) and one year (45% vs. 11%; p<0.05) mortality rates were significantly higher in the >90 group.

CONCLUSIONS: Lower extremity bypass for nonagenarians offers acceptable patency and limb salvage but at a significantly higher mortality rate. Less invasive endovascular options may offer a benefit in this patient population.