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Objectives
As endovascular treatment of lower extremity peripheral vascular disease has evolved and become quicker and safer, many vascular specialists have begun treating patients at age 90 or older that previously would not have been candidates for lower extremity revascularization. It is felt by some providers that this type of treatment in these very elderly patients is preferable to major amputation. There currently is a paucity of literature concerning outcomes of this type of treatment in this cohort of patients. The aim of the study is to determine the morbidity, mortality, and limb salvage rate in patients aged 90 years or older undergoing endovascular treatment of peripheral vascular disease.
Methods
A retrospective chart review of patients 90 years or older who had lower extremity endovascular arterial intervention from 2011 to 2014 was performed. Data including demographics, limb salvage rates, morbidity and mortality were collected.
Results
Within the study period, 34 endovascular lower extremity arterial procedures were performed in 22 patients 90 years or older. Comorbidities recorded included hypertension (21), diabetes (12), hyperlipidemia (10), history of stroke (6), coronary artery disease (6), renal disease (4), COPD (2), and CHF (1). Of the 34 procedures performed, 13 (38%) were for Rutherford 4 disease and 21 (62%) were for Rutherford 5 disease. Twenty-six (76%) procedures were performed as inpatient cases. At 60 day follow-up, there were no major complications and 1 death for a mortality rate of 5%. Also at 60 day follow-up, there was 1 major amputation for a 60 day limb salvage rate of 95%. At 1 year, there were 2 major amputations for a limb salvage rate of 91%. Reintervention was performed within 60 days in 5 patients (15%). Reintervention was performed within 1 year for 11 procedures (32%). There were 4 deaths within 6 months (18%) and 10 deaths within 1 year (45%).
Conclusions
Endovascular lower extremity arterial intervention in nonagenarians is feasible and appears safe. There is minimal early morbidity and mortality in the study cohort. The limb salvage rate is acceptable. Within 1 year follow-up there is a relatively high reintervention rate and a high mortality rate. Further study is needed to determine how best to palliate these elderly patients.