Impact of Age Differences in Chronic Limb-Threatening Ischemia Outcomes in Octogenarians.

BACKGROUND: The aging population is a growing challenge for healthcare services and as such multimorbidity and associated aging are the focus of research programs. Chronic limb-threatening ischemia (CLTI) in the older patient is perceived to be associated with high morbidity and mortality but a potentially contentious area with limited evidence.

METHODS: Retrospective review of all consecutive CLTI admissions to a UK tertiary vascular during 2020. Analysis included descriptive statistics and comparisons by age. The primary outcome was survival (by Kaplan-Meier) with secondary outcomes being major adverse limb and cardiovascular events.

RESULTS: One hundred eighty-three patients with a median age of 72 of which 55 (30%) were octogenarians. Fewer octogenarians were diabetic (38.2% vs. 58.6%, P = 0.015), but comorbidities such as previous stroke (25.5% vs. 10.9%, P = 0.015) and atrial fibrillation (36.4% vs. 16.4%, P = 0.004) were increasingly common. 87.3% of octogenarians had moderate or severe frailty compared to 57.8% in those <80 (P = 0.001) (by electronic frailty index). Median survival time was 30 months with no significant difference between groups (P = 0.406). Major adverse cardiovascular event (10.9% vs. 7.81%, P = 0.504) and major adverse limb event (34.5% vs. 24.2% P = 0.261) were comparable between groups. Octogenarians were less likely to have open surgery (10.9% vs. 25.8%, P = 0.024).

CONCLUSIONS: Octogenarians have similar cardiovascular, limb, and survival outcomes following intervention despite being increasingly frail and comorbid. Holistic assessment, perioperative optimization, and risk stratification are important in this group.