Outcomes After Endovascular Revascularization in Octogenarians and Non-Octogenarians With Critical Limb Ischemia.
PURPOSE
To determine the outcome and periprocedural risk of endovascular revascularization in octogenarians with critical limb ischemia (CLI) compared with their younger counterparts.


METHODS
The multicenter, prospective registry for First-line Treatments in Patients With Critical Limb Ischemia (CRITISCH) enrolled 642 patients treated with endovascular techniques ( ClinicalTrials.gov identifier NCT01877252). The patients were dichotomized according to age <80 years (n=421; mean age 69 years, 292 men; group 1) or ≥80 years (n=221; mean age 85 years, 113 men; group 2). The groups had similar distributions in Rutherford categories 4 to 6, but group 1 had more men, smokers, diabetics, and patients on dialysis. The primary composite endpoint of the study was amputation and/or death. Key secondary endpoints were in-hospital mortality and major amputation, as well as major adverse limb events (MALE; any reintervention or major amputation involving the index limb) at 1 year.


RESULTS
The in-hospital mortality was 1% in group 1 and 2% in group 2 (p=0.204) and the major amputation rates were 4% and 2% (p=0.169), respectively. Amputation-free survival at 1 year was 75% in group 1 and 77% in group 2 (p=0.340), whereas freedom from MALE was significantly different between the groups [62% group 1 vs 72% group 2; hazard ratio (HR) 1.45, 95% confidence interval (CI) 1.09 to 1.93, p=0.016). Limb salvage was 90% in group 1 and 95% in group 2 (HR 2.16, 95% CI 1.27 to 3.69, p=0.01).


CONCLUSION
Octogenarians with CLI treated by endovascular means showed comparable early and 1-year amputation-free survival rates vs their younger counterparts, and limb salvage and freedom from MALE rates were even higher in octogenarians.


APPENDIX
The CRITISCH collaborators are Farzin Adili, MD (Darmstadt), Kai  Balzer, MD (Bonn), Arend Billing, MD (Offenbach), Dittmar Böckler, MD (Heidelberg), Daniel Brixner, MD (Offenbach), Sebastian E. Debus, MD (Hamburg), Hans-Henning Eckstein, MD (München), Hans-Joachim  Florek,  MD  (Freital),  Asimakis  Gkremoutis,  MD (Frankfurt),  Reinhardt  Grundmann,  MD  (Bad  Krozingen),  Thomas   Hupp, MD (Stuttgart), Se-Won Hwang, MD (Muenster), Tobias Keck, MD (Lübeck), Wojciech, Klonek, MD  (Cloppenburg),  Werner  Lang,  MD  (Erlangen),  Björn  May (Freital), Alexander Meyer, MD (Erlangen), Bernhard Mühling,   MD   (Biberach),   Alexander   Oberhuber,   MD   (Düsseldorf),  Holger  Reinecke,  MD  (Münster),  Christian  Reinhold,  MD  (Mönchengladbach),  Ralf-Gerhard  Ritter,  MD   (Bielefeld),   Hubert   Schelzig,   MD   (Düsseldorf), Christian  Schlensack,  MD  (Tübingen),  Thomas  Schmitz-Rixen, MD (Frankfurt), Karl-Ludwig Schulte, MD (Berlin), Matthias Spohn, MD (Bamberg), Konstantinos Stavroulakis, MD  (Münster),  Martin  Storck,  MD  (Karlsruhe),  Matthias  Trede,     MD     (Bremen),     Barbara     Weis-Müller,     MD (Mönchengladbach),   Heiner   Wenk   (Bremen),   Thomas  Zeller, MD (Bad Krozingen), Sven Zhorzel, MD (Munich), and Alexander Zimmermann, MD (Munich).
['Uhl|Christian|C|', 'Steinbauer|Markus|M|', 'Torsello|Giovanni|G|', 'Bisdas|Theodosios|T|', '|||']
D000367:Age Factors D000368:Aged D000369:Aged, 80 and over D000671:Amputation D016638:Critical Illness D057510:Endovascular Procedures D005858:Germany D017052:Hospital Mortality D006801:Humans D007511:Ischemia D023821:Limb Salvage D008875:Middle Aged D058729:Peripheral Arterial Disease D011183:Postoperative Complications D000077982:Progression-Free Survival D011446:Prospective Studies D012042:Registries D012307:Risk Factors D013997:Time Factors
octogenarians critical limb ischemia amputation limb salvage angioplasty elderly patients endovascular therapy infrainguinal arteries popliteal artery stenosis stent superficial femoral artery tibial arteries