Limb Salvage in Octogenarians with Critical Limb Ischemia After Lower Extremity Bypass Surgery.

OBJECTIVES: Peripheral artery disease (PAD) is a worldwide epidemic that affects millions of patients, especially the elderly. It has a prevalence of 20% in individuals greater than 80 years old. Although PAD affects greater than 20% of octogenarians, information about limb salvage rates in this patient population is limited. Therefore, this study aims to understand the impact of bypass surgery on limb salvage in patients age > 80 years with critical limb ischemia.

METHODS: We conducted a retrospective analysis by querying the electronic medical records at a single institution from 2016 through 2022 to identify the population of interest and analyzed their outcomes following lower extremity bypass. The primary outcomes were limb salvage and primary patency with hospital length of stay and 1 year mortality as secondary outcomes.

RESULTS: We identified 137 patients who met the inclusion criteria. The lower extremity bypass population was divided into two cohorts: <80 years old (n = 111) with a mean age of 66 or ≥80 years old (n=26) with a mean age of 84. The gender distribution was similar (p = 0.163). No significant difference was found in the two cohorts when it came to coronary artery disease (CAD), chronic kidney disease (CKD), and diabetes mellitus (DM). However, when current and former smokers were grouped together, they were significantly more common in the younger cohort when compared to non-smokers (p = 0.028). The primary endpoint of limb salvage was not significantly different between the two cohorts (p = 1.0). Hospital length of stay was not significantly different between the two cohorts with 4.13 vs. 4.17 days in the younger vs. octogenarian cohorts, respectively (p=0.95). The 30-day all cause readmissions were also not found to be significantly different between the two groups (p=1.0). Primary patency at 1 year was 75% and 77% (p=0.16) for the <80-year-old and ≥80-year-old cohorts, respectively. Mortality was low in both cohorts, with two and three for the younger and octogenarian populations, respectively, thus no analysis was performed.

CONCLUSIONS: Our study shows that octogenarians who undergo the same pre-operative risk assessment as younger populations have similar outcomes when it comes to primary patency, hospital length of stay, and limb salvage when comorbidities were considered. Further studies need to be done to determine the statistical impact on mortality in this population with a larger cohort.