Abstract：
BACKGROUND: This study aimed to analyze the clinical outcomes after revascularization for chronic limb-threatening ischemia (CLTI) in patients aged ≥ 80 years and < 80 years.
METHODS: We retrospectively analyzed multicenter data of 789 patients who underwent infrainguinal revascularization for CLTI between 2015 and 2021. The end points were 2-year overall survival (OS), amputation-free survival (AFS), limb salvage (LS), and postoperative complications.
RESULTS: A total of 90 patients aged ≥ 80 years and 200 patients aged < 80 years underwent bypass surgery (BSX), and 205 patients aged ≥ 80 years and 294 patients aged < 80 years underwent endovascular therapy (EVT). Before the propensity score matching, multivariate analyses showed that age ≥ 80 years, lower body mass index and serum albumin levels, nonambulatory status, and end-stage renal disease were independent risk factors for 2-year mortality in the BSX and EVT groups. After propensity score matching, the 2-year OS was better in the < 80 years cohort than in the ≥ 80 years cohort in both the BSX and EVT groups (P = 0.018 and P = 0.035, respectively). There was no difference in the 2-year LS rates between the < 80 years and the ≥ 80 years cohorts in both the BSX and EVT groups (P = 0.621 and P = 0.287, respectively). According to the number of risk factors, except for age ≥ 80 years, there was no difference in the 2-year AFS rates between the < 80 years and ≥ 80 years cohorts for the BSX and EVT groups with 0-1 risk factor (P = 0.957 and P = 0.655, respectively). However, the 2-year AFS rate was poor, especially in the ≥ 80 years cohort in the BSX with 2-4 risk factors (P = 0.015). The Clavien-Dindo ≥ IV complication rates tended to be higher in the ≥ 80 years cohort than in the < 80 years cohort only in the BSX with 2-4 risk factors (P = 0.056).
CONCLUSIONS: Patients with CLTI aged ≥ 80 years had poorer OS than those aged < 80 years. However, there was no difference in LS between the ≥ 80 years and < 80 years cohorts in both the BSX and EVT groups. Although age ≥ 80 years was associated with poorer OS, patients with 0-1 risk factor may benefit from revascularization, including BSX, because no difference was observed in AFS or Clavien-Dindo ≥ IV complications.
METHODS: We retrospectively analyzed multicenter data of 789 patients who underwent infrainguinal revascularization for CLTI between 2015 and 2021. The end points were 2-year overall survival (OS), amputation-free survival (AFS), limb salvage (LS), and postoperative complications.
RESULTS: A total of 90 patients aged ≥ 80 years and 200 patients aged < 80 years underwent bypass surgery (BSX), and 205 patients aged ≥ 80 years and 294 patients aged < 80 years underwent endovascular therapy (EVT). Before the propensity score matching, multivariate analyses showed that age ≥ 80 years, lower body mass index and serum albumin levels, nonambulatory status, and end-stage renal disease were independent risk factors for 2-year mortality in the BSX and EVT groups. After propensity score matching, the 2-year OS was better in the < 80 years cohort than in the ≥ 80 years cohort in both the BSX and EVT groups (P = 0.018 and P = 0.035, respectively). There was no difference in the 2-year LS rates between the < 80 years and the ≥ 80 years cohorts in both the BSX and EVT groups (P = 0.621 and P = 0.287, respectively). According to the number of risk factors, except for age ≥ 80 years, there was no difference in the 2-year AFS rates between the < 80 years and ≥ 80 years cohorts for the BSX and EVT groups with 0-1 risk factor (P = 0.957 and P = 0.655, respectively). However, the 2-year AFS rate was poor, especially in the ≥ 80 years cohort in the BSX with 2-4 risk factors (P = 0.015). The Clavien-Dindo ≥ IV complication rates tended to be higher in the ≥ 80 years cohort than in the < 80 years cohort only in the BSX with 2-4 risk factors (P = 0.056).
CONCLUSIONS: Patients with CLTI aged ≥ 80 years had poorer OS than those aged < 80 years. However, there was no difference in LS between the ≥ 80 years and < 80 years cohorts in both the BSX and EVT groups. Although age ≥ 80 years was associated with poorer OS, patients with 0-1 risk factor may benefit from revascularization, including BSX, because no difference was observed in AFS or Clavien-Dindo ≥ IV complications.
摘要：
目的：本研究旨在分析≥80岁和<80岁的CLTI患者血运重建后的临床结局。
方法：我们回顾性分析了2015年至2021年期间接受CLTI治疗的789例患者的多中心数据。终点是2年总生存期（OS），无截肢生存（AFS），肢体抢救（LS），术后并发症。
结果：共有90名年龄≥80岁的患者和200名年龄<80岁的患者接受了搭桥手术（BSX），205例年龄≥80岁的患者和294例年龄<80岁的患者接受了血管内治疗（EVT）。在倾向得分匹配(PSM)之前，多变量分析表明，年龄≥80岁，较低的体重指数（BMI）和血清白蛋白水平，非活动状态,和终末期肾病是BSX和EVT组2年死亡率的独立危险因素.PSM之后,在BSX和EVT组中,<80岁队列的2年OS优于≥80岁队列(分别为P=.018和P=.035).在BSX和EVT组中，<80岁和≥80岁队列之间的2年LS率没有差异（分别为P=.621和P=.287）。根据风险因素的数量，除了年龄≥80岁，有0~1个危险因素的BSX和EVT组,<80岁和≥80岁队列的2年AFS率无差异(分别为P=.957和P=.655).然而,两年的AFS率很低，尤其是在BSX的≥80年队列中，有2-4个危险因素（P=0.015）。仅在具有2-4个危险因素的BSX中，≥80岁队列的Clavien-Dindo≥IV并发症发生率倾向于高于<80岁队列（P=.056）。
结论：年龄≥80岁的CLTI患者的OS低于<80岁的患者。然而,BSX组和EVT组≥80岁和<80岁组的LS无差异.尽管年龄≥80岁与OS较差相关，具有0-1个危险因素的患者可能从血运重建中受益，包括BSX,因为在AFS或Clavien-Dindo≥IV并发症中未观察到差异。
方法：我们回顾性分析了2015年至2021年期间接受CLTI治疗的789例患者的多中心数据。终点是2年总生存期（OS），无截肢生存（AFS），肢体抢救（LS），术后并发症。
结果：共有90名年龄≥80岁的患者和200名年龄<80岁的患者接受了搭桥手术（BSX），205例年龄≥80岁的患者和294例年龄<80岁的患者接受了血管内治疗（EVT）。在倾向得分匹配(PSM)之前，多变量分析表明，年龄≥80岁，较低的体重指数（BMI）和血清白蛋白水平，非活动状态,和终末期肾病是BSX和EVT组2年死亡率的独立危险因素.PSM之后,在BSX和EVT组中,<80岁队列的2年OS优于≥80岁队列(分别为P=.018和P=.035).在BSX和EVT组中，<80岁和≥80岁队列之间的2年LS率没有差异（分别为P=.621和P=.287）。根据风险因素的数量，除了年龄≥80岁，有0~1个危险因素的BSX和EVT组,<80岁和≥80岁队列的2年AFS率无差异(分别为P=.957和P=.655).然而,两年的AFS率很低，尤其是在BSX的≥80年队列中，有2-4个危险因素（P=0.015）。仅在具有2-4个危险因素的BSX中，≥80岁队列的Clavien-Dindo≥IV并发症发生率倾向于高于<80岁队列（P=.056）。
结论：年龄≥80岁的CLTI患者的OS低于<80岁的患者。然而,BSX组和EVT组≥80岁和<80岁组的LS无差异.尽管年龄≥80岁与OS较差相关，具有0-1个危险因素的患者可能从血运重建中受益，包括BSX,因为在AFS或Clavien-Dindo≥IV并发症中未观察到差异。
