PMID- 32927042 OWN - NLM STAT- MEDLINE DCOM- 20210802 LR - 20221207 IS - 1615-5947 (Electronic) IS - 0890-5096 (Linking) VI - 72 DP - 2021 Apr TI - Lower Extremity Revascularization for Chronic Limb-Threatening Ischemia among Patients at the Extremes of Age. PG - 517-528 LID - S0890-5096(20)30820-7 [pii] LID - 10.1016/j.avsg.2020.08.135 [doi] AB - BACKGROUND: Patients with chronic limb-threatening ischemia (CLTI) at the extremes of age are thought to have distinct risk factor profiles and poor outcomes after lower extremity revascularization (LER). The aim of this study is to examine the relationships among age, risk factor profiles, and outcomes of LER in patients with CLTI in a large database focusing on the extreme age groups. METHODS: Patients undergoing LER for CLTI in the Vascular Quality Initiative suprainguinal bypass, infrainguinal bypass, and peripheral vascular intervention files were reviewed through 2019. Patients were stratified into 3 groups: premature peripheral artery disease (PAD) (/=85 years old). Trends in major amputation and mortality by age group were analyzed. RESULTS: There were 156,513 patients who underwent LER for CLTI. Of these, 9,063 (5.79%) patients had premature PAD, 131,694 (84.14%) patients were 51-84 years old, and 15,756 (10.07%) were elderly. Patients with premature PAD were more likely to have insulin-dependent diabetes, be dialysis-dependent, and be active smokers compared to patients 51-84 years old and the elderly. Elderly patients were more likely to undergo an endovascular procedure for tissue loss compared to younger groups. Perioperative and 1-year major amputation rates were highest among patients with premature PAD and decreased with increasing age (P < 0.001), while perioperative and 1-year mortality increased with age (P < 0.001). On multivariable analysis, premature PAD was associated with an increased risk of major amputation (odds ratio, OR = 1.41 [1.22-1.62]), while elderly age was associated with decreased odds of major amputation compared to patients 51-84 years old (OR = 0.61 [0.51-0.73]). CONCLUSIONS: Patients at the extremes of age have significantly different outcomes after LER for CLTI. Although mortality increases with age, the risk of major amputation decreases. Patients with premature PAD constitute a group of patients with a high risk of perioperative and 1-year major amputation. CI - Copyright (c) 2020 Elsevier Inc. All rights reserved. FAU - Kim, Tanner I AU - Kim TI AD - Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT. FAU - Aboian, Edouard AU - Aboian E AD - Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT. FAU - Fischer, Uwe AU - Fischer U AD - Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT. FAU - Zhang, Yawei AU - Zhang Y AD - Department of Surgery, Yale School of Medicine, New Haven, CT; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT. FAU - Guzman, Raul J AU - Guzman RJ AD - Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT. FAU - Ochoa Chaar, Cassius Iyad AU - Ochoa Chaar CI AD - Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT. Electronic address: Cassius.chaar@yale.edu. LA - eng PT - Comparative Study PT - Journal Article DEP - 20200912 PL - Netherlands TA - Ann Vasc Surg JT - Annals of vascular surgery JID - 8703941 SB - IM MH - Age of Onset MH - Aged MH - Aged, 80 and over MH - Aging MH - Amputation, Surgical MH - Chronic Disease MH - Databases, Factual MH - *Endovascular Procedures/adverse effects/mortality MH - Female MH - Humans MH - Ischemia/diagnostic imaging/mortality/physiopathology/*surgery MH - Limb Salvage MH - Lower Extremity/*blood supply MH - Male MH - Middle Aged MH - Peripheral Arterial Disease/diagnostic imaging/mortality/physiopathology/*surgery MH - Risk Assessment MH - Risk Factors MH - Time Factors MH - Treatment Outcome MH - *Vascular Surgical Procedures/adverse effects/mortality EDAT- 2020/09/15 06:00 MHDA- 2021/08/03 06:00 CRDT- 2020/09/14 20:12 PHST- 2020/07/21 00:00 [received] PHST- 2020/08/16 00:00 [revised] PHST- 2020/08/17 00:00 [accepted] PHST- 2020/09/15 06:00 [pubmed] PHST- 2021/08/03 06:00 [medline] PHST- 2020/09/14 20:12 [entrez] AID - S0890-5096(20)30820-7 [pii] AID - 10.1016/j.avsg.2020.08.135 [doi] PST - ppublish SO - Ann Vasc Surg. 2021 Apr;72:517-528. doi: 10.1016/j.avsg.2020.08.135. Epub 2020 Sep 12.