title: Safety and effectiveness of endovascular therapy for claudication in octogenarians.
abstract: BACKGROUND
  Advanced age (≥ 80 years) has been associated with adverse outcomes after lower extremity bypass for critical limb ischemia (CLI), but endovascular therapy (ET) is reported to have comparable safety across age groups. Here, we assess the safety and effectiveness of advanced age on outcomes after ET for lifestyle-limiting intermittent claudication (IC).
  
  
  METHODS
  A retrospective review of a prospectively maintained institutional database (2007-2012) identified all patients undergoing ET for IC. Demographics, procedural details, and outcomes were assessed via univariate analysis and multivariate Cox regression. Effectiveness was assessed across a panel of outcome metrics including the following: overall survival, freedom from major adverse limb event (MALE), and freedom from reintervention, amputation, or restenosis (RAS). Freedom from MALE + perioperative death (MALE + POD) was the primary safety end point.
  
  
  RESULTS
  Two hundred thirty-six patients underwent primary ET for 284 affected limbs. Of these, 46 interventions (16%) were performed in patients ≥ 80 years old. The average age of octogenarians treated was 84.4 years compared with 67.4 years among those aged <80 (P < 0.001). Compared with younger claudicants, octogenarians were less likely to have hypercholesterolemia (43.5% vs. 63.9%, P = 0.01) and more likely to deny a history of smoking (41.3% vs. 14.7%, P < 0.001). Octogenarians were also more likely to undergo interventions involving the popliteal artery (50% vs. 31.9%, P = 0.03). There were no other significant differences in demographics, comorbidities, TransAtlantic Inter-Society Consensus II classification, or treated arterial segment. Thirty-day freedom from MALE + POD was 100% in octogenarians and 99.6% in patients <80 years, with no difference between age groups. There were no differences in freedom from MALE, freedom from RAS, or overall survival at 1- and 3-year follow-up.
  
  
  CONCLUSIONS
  Although age >80 years has been identified as an independent risk factor for poor outcomes in the surgical treatment of CLI, our results suggest that ET for selected octogenarians with lifestyle-limiting claudication is as safe and effective as ET in younger patients. Advanced age alone should not prohibit consideration of ET for patients with IC.
authors.affiliation: Department of Vascular and Endovascular Surgery, New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, NY. Electronic address: Doj9016@nyp.org.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Jones
authors.affiliation: Department of Vascular and Endovascular Surgery, New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, NY.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Siracuse
authors.affiliation: Department of Vascular and Endovascular Surgery, New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, NY.
authors.forename: Ashley
authors.initials: A
authors.lastname: Graham
authors.affiliation: Department of Vascular and Endovascular Surgery, New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, NY.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Connolly
authors.affiliation: Department of Public Health, New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, NY.
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
authors.affiliation: Department of Vascular and Endovascular Surgery, New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, NY.
authors.forename: Darren B
authors.initials: DB
authors.lastname: Schneider
authors.affiliation: Department of Vascular and Endovascular Surgery, New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, NY.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Meltzer
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D015897:Comorbidity; D016638:Critical Illness; D018572:Disease-Free Survival; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D015999:Multivariate Analysis; D018579:Patient Selection; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome