Outcomes After Endovascular Revascularization in Octogenarians and Non-Octogenarians With Critical Limb Ischemia

Purpose: To determine the outcome and periprocedural risk of endovascular revascularization in octogenarians with critical limb ischemia (CLI) compared with their younger counterparts.

Methods: The multicenter, prospective registry for First-line Treatments in Patients With Critical Limb Ischemia (CRITISCH) enrolled 642 patients treated with endovascular techniques ( ClinicalTrials.gov identifier NCT01877252). The patients were dichotomized according to age <80 years (n=421; mean age 69 years, 292 men; group 1) or ≥80 years (n=221; mean age 85 years, 113 men; group 2). The groups had similar distributions in Rutherford categories 4 to 6, but group 1 had more men, smokers, diabetics, and patients on dialysis. The primary composite endpoint of the study was amputation and/or death. Key secondary endpoints were in-hospital mortality and major amputation, as well as major adverse limb events (MALE; any reintervention or major amputation involving the index limb) at 1 year.

Results: The in-hospital mortality was 1% in group 1 and 2% in group 2 (p=0.204) and the major amputation rates were 4% and 2% (p=0.169), respectively. Amputation-free survival at 1 year was 75% in group 1 and 77% in group 2 (p=0.340), whereas freedom from MALE was significantly different between the groups [62% group 1 vs 72% group 2; hazard ratio (HR) 1.45, 95% confidence interval (CI) 1.09 to 1.93, p=0.016). Limb salvage was 90% in group 1 and 95% in group 2 (HR 2.16, 95% CI 1.27 to 3.69, p=0.01).

Conclusion: Octogenarians with CLI treated by endovascular means showed comparable early and 1-year amputation-free survival rates vs their younger counterparts, and limb salvage and freedom from MALE rates were even higher in octogenarians.

Appendix: The CRITISCH collaborators are Farzin Adili, MD (Darmstadt), Kai Balzer, MD (Bonn), Arend Billing, MD (Offenbach), Dittmar Böckler, MD (Heidelberg), Daniel Brixner, MD (Offenbach), Sebastian E. Debus, MD (Hamburg), Hans-Henning Eckstein, MD (München), Hans-Joachim Florek, MD (Freital), Asimakis Gkremoutis, MD (Frankfurt), Reinhardt Grundmann, MD (Bad Krozingen), Thomas Hupp, MD (Stuttgart), Se-Won Hwang, MD (Muenster), Tobias Keck, MD (Lübeck), Wojciech, Klonek, MD (Cloppenburg), Werner Lang, MD (Erlangen), Björn May (Freital), Alexander Meyer, MD (Erlangen), Bernhard Mühling, MD (Biberach), Alexander Oberhuber, MD (Düsseldorf), Holger Reinecke, MD (Münster), Christian Reinhold, MD (Mönchengladbach), Ralf-Gerhard Ritter, MD (Bielefeld), Hubert Schelzig, MD (Düsseldorf), Christian Schlensack, MD (Tübingen), Thomas Schmitz-Rixen, MD (Frankfurt), Karl-Ludwig Schulte, MD (Berlin), Matthias Spohn, MD (Bamberg), Konstantinos Stavroulakis, MD (Münster), Martin Storck, MD (Karlsruhe), Matthias Trede, MD (Bremen), Barbara Weis-Müller, MD (Mönchengladbach), Heiner Wenk (Bremen), Thomas Zeller, MD (Bad Krozingen), Sven Zhorzel, MD (Munich), and Alexander Zimmermann, MD (Munich).