Conservative Treatment Has a Role in Elderly Patients with Chronic Limb-Threatening Ischemia, Especially in Very Elderly Patients (≥ 85 years).

BACKGROUND: This study primarily aimed to assess mortality and amputation-free survival in elderly patients with chronic limb-threatening ischemia (CLTI) treated with conservative management, open surgical revascularization, or endovascular revascularization therapy (ERT). The secondary objective was to identify any risk factors associated with mortality in this cohort and to identify which of the survival-related variables are associated with the decision for conservative treatment.A single-center retrospective cohort study was conducted to evaluate patients aged ≥65 years diagnosed with CLTI for the first time between 2013 and 2020.

METHODS: Patient demographics, treatment details, and outcomes up to 5 years were collected. Overall survival and amputation-free survival were analyzed using Kaplan-Meier estimate curves. The estimated effects on survival and amputation-free survival were assessed with a Cox proportional hazards regression model.

RESULTS: A total of 743 patients were included. Conservative treatment has a role in elderly patients with CLTI and was frequently initiated (30.1%). Conservative treatment resulted in a 1-year survival of 58% and an amputation-free survival of 54%, and a 5-year survival of 14% and an amputation-free survival of 13%. In patients aged ≥85 years conservative treatment had a 1-year survival of 52%, which was a similar trend to the survival of 51% after ERT. Independent associations with mortality were found for age, preoperative hemoglobin, American Society of Anesthesiologists score, Fontaine classification, femoropopliteal Trans-Atlantic Inter-Society Consensus, a history of chronic obstructive pulmonary disease, cardiac disease and cerebrovascular accident, estimated glomerular filtration rate, and postoperative complications (delirium, pneumonia, and acute myocardial infarction).

CONCLUSION: This study showed that conservative treatment should be considered as an appropriate treatment option in frail high-risk elderly patients, particularly those with a predicted survival of less than 2 years. The findings emphasize the significance of integrating patient specific factors into the process of treatment and shared decision making.