Outcome and influence of age after infrainguinal revascularisation in critical limb ischaemia

Objectives:To evaluate whether revascularisation has any influence on the mortality rate, and the impact of old age in patients with critical limb ischaemia (CLI).Design:Analysis of Swedish Vascular Registry (Swedvasc) data.Patients and methods:During 1987–1995, 3730 surgical and 1199 endovascular (PTA) procedures below the groin due to CLI were reported. At 1 year three groups were defined: “occluded, amputated”; “occluded, not amputated” and “patent”. Survival was also calculated. Clinical outcome at 1 month and at 1 year was defined as: patient “alive, improved”, “alive, not improved”, “alive, amputated” and “dead”. Two age groups: ≤75 years or and ≥76 years were compared.Results:The mortality rate for the whole group was 5.3% at 1 month and 22.9% at 1 year, with no difference between the Surgery and PTA groups. Significantly more patients were alive and improved after surgery than after PTA at 1 month (82.3% vs. 77.7%) and at 1 year (49.6% vs. 44.3%). The amputation rate was 5.6% at 1 month and 14.4% at 1 year; 17% for diabetics. After surgery, the cumulative mortality rate did not differ between patients with a salvaged limb, irrespectively of patency of the re-construction, but was significantly higher after amputation. After PTA, only a reconstruction reported as patent was linked to the most favourable survival rate. The older patient group had a mortality rate of 6.4% at 1 month and 26.4% at 1 year, significantly higher than the younger group (3.8% and 17.6%, respectively). The amputation rate did not differ according to age. Significantly more patients were alive but not improved in the older group.Conclusions:The outcome of surgery vs. PTA was similar regarding survival and amputation, but surgery resulted in a greater improvement although this might be due to selection. Older patients and those with an amputation had higher mortality rates