PMID- 35507077
OWN - NLM
STAT- MEDLINE
DCOM- 20221005
LR  - 20221207
IS  - 1432-2323 (Electronic)
IS  - 0364-2313 (Linking)
VI  - 46
IP  - 11
DP  - 2022 Nov
TI  - Critical Limb Ischemia in Nonagenarians: A Challenge of Our Times.
PG  - 2825-2831
LID - 10.1007/s00268-022-06570-5 [doi]
AB  - BACKGROUND: As a result of the increasing life expectancy of the western 
      population, the number of older patients with chronic limb-threatening ischemia 
      (CLTI) seeking medical care is growing. Our objective was to describe the 
      characteristics of a consecutive series of nonagenarian patients with CLTI and 
      evaluate the outcomes of their management. MATERIALS AND METHODS: Retrospective 
      analysis of a consecutive series of nonagenarian patients with CLTI attended at 
      our institution between 2005 and 2019. Primary endpoints were 1-year limb salvage 
      and survival rates. RESULTS: A total of 171 patients were included (mean age 
      92.7, 51.5% women), of which in 59 (34.5%) primary major amputation (n = 10) or 
      palliative care (n = 49) was indicated at presentation because of severe dementia 
      (n = 30, 50.8%), knee retraction (n = 17, 28.8%), terminal condition (n = 13, 
      22%) or a non-salvageable foot (n = 28, 47.4%). In the remaining 112 (65.5%), the 
      need for a revascularization was further assessed finally performing A) 
      conservative treatment/minor amputation (n = 57, 50.9%), B) revascularization 
      (n = 50, 44.6%) or C) direct major amputation (n = 5, 4.4%), with 1-year limb 
      salvage and survival rates of 93.1 and 57.4%, respectively. Predictive factors 
      for lower survival included age >92 years (HR = 1,59, p = 0.041), 
      hemoglobin <10.5 mg/dL (HR 2,34, p < 0.001), congestive heart failure 
      (HR = 1.65, p = 0.036), non-severe dementia (HR 3,11, p < 0.001) and current 
      mobility with wheelchair (HR 1,74, p = 0.014). CONCLUSION: Nearly one-third of 
      nonagenarian patients with CLTI have a direct indication for amputation or 
      palliative care at presentation. In the remaining, a judicious approach with 
      conservative treatment, minor amputation or revascularization procedures yields 
      excellent limb salvage rates. Survival is, however, the cornerstone of these 
      patients. It can be predicted with certain clinical factors which may help 
      decision-making.
CI  - (c) 2022. The Author(s) under exclusive licence to Societe Internationale de 
      Chirurgie.
FAU - Casajuana Urgell, Eduard
AU  - Casajuana Urgell E
AUID- ORCID: 0000-0002-3699-5885
AD  - Department of Vascular and Endovascular Surgery, Hospital del Mar, Passeig 
      Maritim 25-29, 08003, Barcelona, Spain.
AD  - Department of Surgery, Universitat Autonoma de Barcelona, Barcelona, Spain.
FAU - Calsina Juscafresa, Laura
AU  - Calsina Juscafresa L
AD  - Department of Vascular and Endovascular Surgery, Hospital del Mar, Passeig 
      Maritim 25-29, 08003, Barcelona, Spain. lcalsina@parcdesalutmar.cat.
AD  - Department of Medicine and Surgery, Universitat Pompeu Fabra, Barcelona, Spain. 
      lcalsina@parcdesalutmar.cat.
FAU - Nieto Fernandez, Lluis
AU  - Nieto Fernandez L
AD  - Department of Vascular and Endovascular Surgery, Hospital del Mar, Passeig 
      Maritim 25-29, 08003, Barcelona, Spain.
FAU - Romero Montana, Lorena
AU  - Romero Montana L
AD  - Department of Vascular and Endovascular Surgery, Hospital del Mar, Passeig 
      Maritim 25-29, 08003, Barcelona, Spain.
FAU - Llort Pont, Carme
AU  - Llort Pont C
AD  - Department of Vascular and Endovascular Surgery, Hospital del Mar, Passeig 
      Maritim 25-29, 08003, Barcelona, Spain.
FAU - Clara Velasco, Albert
AU  - Clara Velasco A
AD  - Department of Vascular and Endovascular Surgery, Hospital del Mar, Passeig 
      Maritim 25-29, 08003, Barcelona, Spain.
AD  - Department of Medicine and Surgery, Universitat Pompeu Fabra, Barcelona, Spain.
AD  - CIBER Cardiovascular, Barcelona, Spain.
LA  - eng
PT  - Journal Article
DEP - 20220504
PL  - United States
TA  - World J Surg
JT  - World journal of surgery
JID - 7704052
SB  - IM
CIN - World J Surg. 2022 Nov;46(11):2832-2833. PMID: 35982338
MH  - Aged, 80 and over
MH  - Amputation, Surgical
MH  - Chronic Limb-Threatening Ischemia
MH  - *Dementia/etiology
MH  - *Endovascular Procedures
MH  - Female
MH  - Humans
MH  - Ischemia/etiology/surgery
MH  - Limb Salvage
MH  - Male
MH  - Nonagenarians
MH  - *Peripheral Arterial Disease/complications/surgery
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2022/05/05 06:00
MHDA- 2022/10/06 06:00
CRDT- 2022/05/04 11:15
PHST- 2022/04/11 00:00 [accepted]
PHST- 2022/05/05 06:00 [pubmed]
PHST- 2022/10/06 06:00 [medline]
PHST- 2022/05/04 11:15 [entrez]
AID - 10.1007/s00268-022-06570-5 [pii]
AID - 10.1007/s00268-022-06570-5 [doi]
PST - ppublish
SO  - World J Surg. 2022 Nov;46(11):2825-2831. doi: 10.1007/s00268-022-06570-5. Epub 
      2022 May 4.