Prognostic analysis of endovascular treatment for acute lower limb ischemia in patients older than 80 years of age

Abstract

BACKGROUND AND OBJECTIVES: Current treatment strategies for elderly patients with acute lower limb ischemia (ALLI) have no definitive effect, and studies have reported no definitive prognostic factors that reflect poor outcomes among patients with ALLI. Therefore, reliable clinical indicators that can accurately predict outcomes and guide the choice of treatment options are needed. This study aimed to identify prognostic factors among the elderly patients who underwent endovascular treatment for ALLI. DESIGN: Retrospective. MATERIALS AND METHODS: From January 2011 to December 2020, 270 patients (281 limbs; 124 males; mean age: 84.8 years [range, 80–102 years]) underwent endovascular therapy for ALLI, including acute limb arterial embolism (191 limbs) and acute exacerbation of chronic ischemia (90 limbs). Factors identified through univariate analysis (P < 0.1) and other variables considered likely to have important prognostic value were tested in a logistic regression model for symptom improvement, major amputation, and all-cause mortality. RESULTS: The mean age of the patients was 84.8 years, 54.1% were female, and hypertension (69.0%) was the most common coexisting disease. Patients in the acute group exhibited higher rates of atrial fibrillation (45.5% vs. 24.4%; P = 0.001) and chronic renal failure (15.2% vs. 6.7%; P = 0.044) than the acute-on-chronic group. The acute group exhibited significantly higher plasma D-dimer levels than the acute-on-chronic group (1.59 vs. 1.06; P < 0.001). In the acute group, 145 (75.9%) limbs had preacute Rutherford Classification (RC) of Grade I. In the acute-on-chronic group, 47 (52.2%) limbs had symptom duration of 7–14 days, and 84 (93.3%) limbs were diagnosed with arteriosclerosis obliterans. Most patients opted for antiplatelet therapy, particularly those in the acute-on-chronic group. Multivariate logistic regression analysis revealed that onset time, hypertension, white blood cell (WBC) count, and lesion nature were independent factors for postoperative symptom improvement, whereas hypertension, WBC count, and preacute RC grade were independent factors for amputation at 3 months postoperatively. CONCLUSIONS: WBC count was a major risk factor for postoperative symptom improvement and amputation within 3 months among elderly patients; the higher the WBC count, the higher the risk for amputation. In addition, among patients >80 years of age, early surgery could significantly improve the prognosis of ALLI, regardless of the procedure used to restore blood supply.