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Objective: The efficacy and safety of infrainguinal endovascular interventions in the nonagenarian has not been well defined. This study describes the outcomes of these therapies in the nonagenarian.
Methods: A total of 804 patients underwent infrainguinal endovascular procedures in the interventional suites at our institution from March 2006 to October 2010. Thirteen of these patients were older than 90 years. Data with respect to demographics, comorbidities, indications for intervention, perioperative events and outcome was reviewed.
Results: Fifteen limbs in thirteen patients were treated. There were five men (38.5%) and eight women (61.5%). The mean age at the time of the procedure was 92.6 (range, 90-102 years). The mean follow up was 12.3 months (range, 0-52 months). Comorbidities including hypertension (76.9%), coronary artery disease (30.2%), diabetes (38.5%), chronic renal insufficiency (23.1) and hypercholesterolemia (30.8%) were common among these patients. Two patients had previous undergone bypass graft surgery in one limb. Twelve (92.3%) patients had critical limb ischemia, and one patient presented with claudication. Ten limbs exhibited tissue loss and four had ischemic rest pain. Angioplasty alone was performed in six limbs (40%) and angioplasty with stenting in nine limbs (60%). Technical success was achieved in 93.3% cases. One case was terminated because of the patient’s instability during the intervention. The overall complication rate was 20% including a hematoma in two cases and one case of pseudoaneurysm. There was no death within 30 days of the intervention. The limb salvage rate was 86.7%. There was one case of an above the knee amputation at 2 months post procedure and one case of a transmetatarsal amputation at 9 months. Repeat endovascular intervention was performed in four limbs (26.7%).
Conclusion: Infrainguinal endovascular interventions can be performed safely and successfully in the nonagenarian with a low complication rate.