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Is the Incidence of Lower Extremity Amputation Higher in Older Patients (>70) Presenting with Critical Limb Ischemia?
Nicholas J. Gargiulo, III, MD FACS1, Yana Etkin, MD2.
1Hofstra University School of Medicine/NYIT Osteopathic School of Medicine, North Shore-LIJ Health, Old Bethpage, NY, USA, 2University of Pennsylvania, Philadelphia, PA, USA.
OBJECTIVES:
Average life expectancy continues to increase, and as a result a patient's age has become an important factor in the management and outcome of critical limb ischemia (CLI). This study was done to determine if age plays a role in presentation, management and outcome of CLI.
METHODS:
A retrospective review of all patients that presented with CLI from January 1, 2007 to December 31, 2007 was conducted. CLI was defined as ischemic rest pain, non-healing ulceration or gangrene. 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 >70 compared to those <70 years old. 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. Significance defined as p<0.05.
RESULTS:
One hundred and forty eight patients presented with CLI over this one year period. There were 82 (55%) individuals <70 years old and 66 (45%) >70 years old. The two groups had similar demographics. Patients in the >70 group were more likely to present with Rutherford Class 5 (ulceration/gangrene) disease. Both groups had similar rates of TASC II D iliac disease (p>0.05), however, the > 70 group had a higher prevalence of TASC II D femoropopliteal disease (56% vs. 37%, p<0.05) and a higher prevalence of infrapopliteal disease (66% vs. 52%, p<0.05). Patients in the >70 group were more likely to be treated with open procedures and had higher postoperative mortality (6.45% vs. 1.21%, p<0.05). One year amputation rate was significantly higher in the >70 group population (15% vs. 6%, p<0.05). Average primary patency rates in both groups were about 24 months. Rate of re-interventions was similar in both groups (17% vs. 15%, p>0.05).
CONCLUSIONS:
Patients over seventy years of age (>70) are more likely to present with TASC II D femoropopliteal and infrapopliteal disease. This may be attributed to a higher one year amputation rate in this group. Postoperative mortality is also higher in the >70 group. Primary patency and re-intervention rates do not appear to be age dependent.
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