Peripheral arterial disease in octogenarians and nonagenarians: factors predicting survival.

BACKGROUND: To describe the prevalence and character of complications associated with revascularization procedures as a result of peripheral arterial disease in octogenarians and nonagenarians and to assess their overall survival depending on baseline characteristics, type of treatment modality, and possible procedure-related complications. A retrospective clinical study was carried out.

METHODS: A total of 383 patients aged >80 years, referred with suspected peripheral arterial disease, were categorized into octogenarians and nonagenarians. Data regarding cardiovascular risk factors, comorbidities, type of treatment, and possible procedure-related complications were collected from patients' files. The cohort was followed up for total mortality until December 31, 2007, by means of record linkage with the National Causes of Death Register.

RESULTS: A total of 57 (14.9%) patients were treated surgically, whereas 71 (18.5%) underwent an endovascular procedure. Conservative treatment was chosen significantly more often for nonagenarians (p = 0.032). Postoperative complications (nonfatal, 13.2%; fatal, 3.1%) were equally distributed between the age groups and genders (p = 0.840 and p = 0.820, respectively) but were significantly more common after surgical procedures (p < 0.001 for both fatal and nonfatal complications). As expected, the overall survival was significantly poorer among nonagenarians as compared with octogenarians (33 vs. 45 months, respectively; p < 0.001). Older age, critical limb ischemia (CLI), and males were independently associated with mortality (odds ratio [OR]: 1.89, 95% confidence levels [CI]: 1.18-3.04; OR: 3.72, 95% CI: 2.34-5.91; and OR: 1.77, 95% CI: 1.10-2.80, respectively). The survival for nonagenarian men with CLI was 24 months and for women 28, regardless of the treatment modality.

CONCLUSIONS: Octo- and nonagenarians seem to tolerate arterial reconstruction relatively well. Endovascular interventions should be favored over surgical procedures as they are associated with fewer complications. At the same time, the life expectancy of nonagenarians with CLI is limited to approximately 2 years, irrespective of the method of treatment. Further studies should be conducted to clarify the actual effect of vascular reconstructions among the elderly population with regard to benefits of both costs and quality of life.