C. Rivera1, N. J. Gargiulo1 1North Shore University And Long Island Jewish Medical Center,Vascular Surgery,Manhasset, NY, USA
Introduction: As average life expectancy has risen, a patients age has become an important factor in the management and outcome of many pathological processes. This study was done to determine if age plays a role in presentation, management and outcome of peripheral arterial disease i.e. critical limb ischemia (CLI).
Methods:
This is a prospective review of all patients that presented to our institution with CLI from January 1, 2007 to December 31, 2007. CLI was defined as ischemic rest pain, non-healing ulceration or gangrene (Rutherford Class 4 and 5). All patients underwent conventional arteriography and if possible an endovascular, open or hybrid procedure for limb salvage. Data was analyzed to determine any significant differences in presentation and outcomes in the group of patients under seventy years of age compared to those over seventy years of age. Data points included in the analysis were: Rutherford class, TransAtlantic InterSociety Consensus II (TASC II) classification, types of intervention (open, endovascular or hybrid), in hospital mortality, one-year amputation free survival and rate on re-intervention.
Results: One hundred and forty eight patients presented with CLI over this one year period. Of these, 82 (55%) were under seventy years old and 66 (45%) were older. The two groups had similar demographics. Patients in the older group were more likely to present with Rutherford class 5 lesions. Both groups had similar rates of TASC II D iliac disease, however older patients had a higher prevalence of TASC II D femoropopliteal disease (56% vs. 37%) and a higher prevalence of TASC II D infrapopliteal disease (66% vs. 52%). Patients in the older group were more likely to be treated with open procedure and had higher postoperative mortality (6.45% vs. 1.21%). One year amputation rate was significantly higher in the older population (15% vs. 6%). Average primary patency rates in both groups were about 24 months. Rate of re-interventions was similar in both groups (17% vs. 15%).
Conclusion: Patients over seventy years of age are more likely to present with more severe TASC II D femoropopliteal and infrapopliteal disease. This may be attributed to higher one year amputation rates in this group. Postoperative mortality is also higher in older population. Primary patency and re-intervention rates do not depend on patients’ age.