title: Infrainguinal percutaneous transluminal angioplasty or bypass surgery in patients aged 80 years and older with critical leg ischaemia.
abstract: BACKGROUND
  Infrainguinal revascularization for critical leg ischaemia (CLI) in patients aged 80 years and over is associated with increased operative risk. The aim was to compare the results of percutaneous transluminal angioplasty (PTA) and bypass surgery in these patients.
  
  
  METHODS
  Some 584 consecutive patients aged at least 80 years treated with either PTA (277) or bypass surgery (307) for CLI between 2000 and 2007 were included in this study.
  
  
  RESULTS
  After 2 years PTA achieved better results than bypass surgery (leg salvage: 85.4 versus 78.7 per cent, P = 0.039; survival: 57.7 versus 52.3 per cent, P = 0.014; amputation-free survival (AFS): 53.0 versus 44.9 per cent, P = 0.005). Cox regression analysis showed that increased age (relative risk (RR) 1.05, 95 per cent confidence interval 1.02 to 1.08), decreased estimated glomerular filtration rate (RR 0.99, 0.99 to 1.00), diabetes (RR 1.30, 1.04 to 1.62), coronary artery disease (RR 1.36, 1.05 to 1.75) and bypass surgery (RR 1.55, 1.24 to 1.93) were associated with decreased AFS. In 95 propensity score-matched pairs, leg salvage at 2 years (88 versus 75 per cent; P = 0.010) and AFS (53 versus 45 per cent; P = 0.033) were significantly better after PTA. Classification and regression tree analysis suggested that PTA was associated with better 1-year AFS, especially in patients with coronary artery disease (63.8 versus 48.9 per cent; P = 0.008).
  
  
  CONCLUSIONS
  When feasible, a strategy of PTA first appears to achieve better results than infrainguinal bypass surgery in patients aged 80 years and older.
authors.affiliation: Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland. eva.arvela@hus.fi.
authors.forename: E
authors.initials: E
authors.lastname: Arvela
authors.forename: M
authors.initials: M
authors.lastname: Venermo
authors.forename: M
authors.initials: M
authors.lastname: Söderström
authors.forename: M
authors.initials: M
authors.lastname: Korhonen
authors.forename: K
authors.initials: K
authors.lastname: Halmesmäki
authors.forename: A
authors.initials: A
authors.lastname: Albäck
authors.forename: M
authors.initials: M
authors.lastname: Lepäntalo
authors.forename: F
authors.initials: F
authors.lastname: Biancari
mesh_terms: D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000401:mortality; D017130:Angioplasty / Q000379:methods / Q000401:mortality*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods / Q000401:mortality; D057510:Endovascular Procedures / Q000401:mortality; D005260:Female; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D007866:Leg / Q000098:blood supply*; D008297:Male; D057216:Propensity Score