Life Expectancy and Outcome of Different Treatment Strategies for Critical Limb Ischemia in the Elderly Patients

Autor: Paul Mulder, Lijckle van der Laan, Gwan H. Ho, Sanne Klaphake, Eelco J. Veen, Kevin de Leur, Hans de Groot
Rok vydání: 2017
Předmět:
Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Critical Illness
Population
Longevity
Comorbidity
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
030230 surgery
Conservative Treatment
Amputation
Surgical
Disease-Free Survival
03 medical and health sciences
Peripheral Arterial Disease
0302 clinical medicine
Ischemia
Risk Factors
Internal medicine
medicine
Humans
education
Aged
Netherlands
Proportional Hazards Models
Retrospective Studies
Aged
80 and over
education.field_of_study
Proportional hazards model
business.industry
Mortality rate
Endovascular Procedures
Age Factors
General Medicine
Critical limb ischemia
medicine.disease
Surgery
Treatment Outcome
Amputation
Life expectancy
Population study
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Zdroj: Annals of vascular surgery. 46
ISSN: 1615-5947
Popis: The treatment of critical limb ischemia (CLI) in the elderly patients is challenging because of the comorbidity and fragility of these patients. We analyzed survival in relation to different treatment options and estimated life expectancy of our study group by age and gender.All patients aged ≥70 years, presenting with chronic CLI, between 2006 and 2013 were included. The treatment was conservative, endovascular, surgical, or by primary major amputation. The interest was in the effect of conservative versus nonconservative treatment on survival. Furthermore, we compared mortality and life expectancy between the study population to the overall Dutch population by age and gender.In total, 686 legs in 651 patients were treated. Initial treatment of patients was conservative (n = 181), endovascular (n = 259), surgical (n = 169), or amputation (n = 42). The overall 1-year mortality was 29%. Patients were stratified by age: 70-79 (n = 350) years and ≥80 (n = 301) years. Higher mortality rate ratios (RR) were found in octogenarians compared with patients aged 70-79 years, in the endovascular (P 0.001) and surgical (P 0.001) group. The mortality RRs of conservative relatively to nonconservative treatment was 0.84 (95% confidence interval: 0.65-1.09; P = 0.19), not significantly differing between both age groups (P = 0.74). The mortality RR of 3.72 of our study population to the Dutch general population was high, with an excess mortality of 272%. Life expectancy at the age of 70 years was substantially decreased by 9 and 8 years for, respectively, the male and female population.Mortality rates in elderly patients with CLI are high, corresponding with a decreased life expectancy, regardless of the type of intervention. Revascularization is associated with high periprocedural mortality, especially in octogenarians. Conservative treatment is noninferior to nonconservative treatment in terms of mortality and should be considered as the treatment in octogenarians with substantial comorbidity.
Databáze: OpenAIRE
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