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Acute limb ischemia in nonagenarians: Characteristics and factors related to outcomes in a single-center consecutive series.
Casajuana Urgell, Eduard; Calsina Juscafresa, Laura; Mascaró Oliver, Maria; Abadal Jou, Mar; Clarà Velasco, Albert.
Afiliación
  • Casajuana Urgell E; Department of Vascular Surgery, Hospital del Mar, Barcelona, Spain.
  • Calsina Juscafresa L; Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain.
  • Mascaró Oliver M; Department of Vascular Surgery, Hospital del Mar, Barcelona, Spain.
  • Abadal Jou M; Department of Life and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
  • Clarà Velasco A; Department of Vascular Surgery, Hospital del Mar, Barcelona, Spain.
World J Surg ; 48(1): 240-249, 2024 01.
Article en En | MEDLINE | ID: mdl-38686799
ABSTRACT

BACKGROUND:

The increasing aging and frailty of the population make the management of acute limb ischemia (ALI) more difficult, with decision-making far from being guided by evidence. The aim of the study was to evaluate the characteristics and results of ALI treatment in nonagenarians. MATERIALS AND

METHODS:

Retrospective analysis of a consecutive series of nonagenarian patients with ALI attended at our institution between 2008 and 2021. The primary outcomes of the study were 1-year limb salvage and survival rates.

RESULTS:

A total of 102 patients were included (mean age 92.38, 78.4% women). In 83 cases (81.4%) ALI was attributed to embolism, and 19 (18.6%) to acute arterial thrombosis. One-month overall survival was 70.6%. Fifteen patients (14.7%) were treated palliatively, including 8 (53.3%) irreversible ALI with associated malignancy/advanced dementia, 5 (33.3%) with associated cerebral/intestinal ischemia and 2 (13.3%) with aortic occlusion and poor medical condition. None of these patients survived after 10 days. The remaining 87 patients (85.3%) were treated with isolated anticoagulation (n = 8, 9.1%), primary major amputation (n = 1, 1.1%) or revascularization (n = 78, 89.6%), including 69 (67.6%) embolectomies, 6 (5.9%) bypass and 3 (2.9%) endovascular techniques. One-year limb salvage and survival rates were 96% and 48%, respectively. Predictive factors of lower survival included anemia (HR = 1.81, p = 0.014) and ALI severity (HR = 1.73, p = 0.032), but not cognitive or functional status. Patients surviving the ALI episode had a 1-year survival rate significantly below that of a similar matched population.

CONCLUSION:

Although nonagenarians with an ALI are often functionally and cognitively impaired and have a limited life expectancy, most patients need revascularization for limb salvage and this can be done successfully with a low invasive surgery.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Recuperación del Miembro / Isquemia Límite: Aged80 / Female / Humans / Male Idioma: En Revista: World J Surg Año: 2024 Tipo del documento: Article País de afiliación: España Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Recuperación del Miembro / Isquemia Límite: Aged80 / Female / Humans / Male Idioma: En Revista: World J Surg Año: 2024 Tipo del documento: Article País de afiliación: España Pais de publicación: Estados Unidos