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Age at Revascularization Does Not Predict Need for Reintervention in Patients with Femoropopliteal Occlusive Disease
Daniel J. Torrent, MD, Jill N. Zink, MD, William M. Bogey, Jr., MD, Charles S. Powell, MD, Frank M. Parker, DO, Dean J. Yamaguchi, MD, Nishika S. Patel, Avery G. Colomb, Aseem G. Kaul, Michael C. Stoner, MD.
East Carolina University, Greenville, NC, USA.
OBJECTIVES:
Conventional wisdom holds that patients with need for intervention at a younger age have more aggressive disease, although there is a paucity of supportive literature. The purpose of this study is to evaluate this assumption.
METHODS:
A retrospective cohort of patients undergoing endovascular or open revascularization for femoropopliteal occlusive disease (FPOD) over a four year period was assembled. Demographic information, comorbidities, disease characteristics, and time to last follow up, or death were recorded. Time to major revascularization or amputation, major adverse limb event (MALE), was also recorded. The patients were stratified by age into three groups: the youngest quartile, the oldest quartile, and the middle two quartiles. Univariate and multivariate methods were used to analyze the data.
RESULTS:
There were 229 patients in the cohort representing a total of 206,925 days of follow up. The mean age was 64.5±0.85. The overall mean time to MALE or death was 1216.8±85.9 days. The younger group was 54 years old and younger (n=57), the middle group was 55 to 74 years old (n=111), and the older group was 75 years old and older (n=61). Significant findings on univariate analysis (table) included more severe disease at presentation in the older age group and a higher proportion of secondary revascularization and amputation in the younger group. A Kaplan-Meier curve to MALE or death approached significance (p=0.06) with median time to event for the younger, middle and older groups at 253, 1083, and 865 days respectively. A Cox regression model was constructed and age group was not significantly correlated with time to MALE or death (p=0.57) when controlling for confounders.
CONCLUSIONS:
These data refute the common assumption that younger patients in need of intervention for FPOD have more aggressive disease. It is the older population that has more severe disease before intervention, and although on univariate analysis they have a lower proportion of amputation and secondary revascularization this is confounded by a higher rate of death in this population. The younger cohort has a longer life expectancy, and as such a longer timer period during which re-intervention may be required.
Differences in disease severity, significant comorbidities, and outcomes on univariate analysis| Variable | <55 (n=57) | 55-74 (n=111) | >74, (n=61) | P | | Rutherford Class 5 | 21.8% | 25.5% | 41.8% | 0.05 | | Critical Limb Ischemia | 48.2% | 49.5% | 71.7% | 0.009 | | Open Procedure | 66.7% | 78.4% | 60.7% | 0.04 | | History of Smoking | 69.2% | 72.3% | 43.4% | 0.002 | | Quit Smoking | 15.4% | 34.1% | 24.5% | 0.04 | | Secondary Revascularization | 43.9% | 37.7% | 18.0% | 0.004 | | Amputation | 28.1% | 10.8% | 21.7% | 0.02 |
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