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Ambulatory Outcomes After Infrainguinal Revascularization For CLTI In Octogenarians
Navya Sinha, BS, Jeremy D. Darling, MD, Camila R. Guetter, MD, MPH, Marc L. Schermerhorn, MD, Lars Stangenberg, MD, PhD.
BIDMC, Boston, MA, USA.
OBJECTIVES: Several studies have evaluated the optimal revascularization strategy for patients with CLTI regarding both limb- and patient-centered outcomes; however, few have examined the effect that revascularization type may have on long-term ambulation, particularly in octogenarians.
METHODS: We studied 489 octogenarians undergoing first-time infrainguinal bypass grafting (BPG) or percutaneous transluminal angioplasty ± stenting (PTA/S) for CLTI at a single institution between 2005-2022. Only patients who survived through follow-up, were not lost to follow-up, and had complete data regarding ambulation were included. Ambulation was recorded on an ordinal scale (1 = independent, 2 = with assistance, 3 = wheelchair, 4 = bedbound) at baseline and follow-up (1, 3, 6, and 12-15 months). For analysis, ambulation was grouped at 1-3 months and 6-15 months, using the latest status if multiple assessments were available. Patients were then grouped by ambulation decline versus no decline. Logistic regression compared decline at both follow-up times.
RESULTS: Overall, 311 PTA/S and 166 BPG patients that had complete follow-up data at 1-3 months and 209 PTA/S and 85 BPG patients at 6-15 months were included.
PTA/S patients were more often non-White (30% vs 16%) and female (51% vs 40%), more likely to be independent at baseline (62% vs 30%), and less likely to have CAD (44% vs 63%) or reside in a nursing home (16% vs 44%) (all P<.05). At 1-3 months, 24% of BPG vs 27% of PTA/S patients declined, 64% vs 58% remained unchanged, and 12% vs 16% improved (P = 0.36). At 6-15 months, 33% vs 36% declined, 52% vs 52% remained unchanged, and 15% vs 12% improved (P = 0.71). Following adjustment, compared to PTA/S, BPG did not demonstrate any difference in ambulation decline at 1-3 or 6-15 months (aOR 0.98, 95% CI [0.48-2.00] and aOR 0.77 [0.28-2.04], respectively). No assessed demographics or comorbidities were associated with decline in ambulation.
CONCLUSIONS: Although a greater proportion of patients declined rather than improved, ambulation was generally preserved in octogenarians undergoing a first-time infrainguinal PTA/S or BPG. Future studies incorporating patient-centered functional measures and comprehensive geriatric assessments are needed to more accurately identify individuals at risk for mobility decline to better guide patients towards interventions that may preserve independence.
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