The aging of the population leads us to treat older patients, in particular presenting with acute limb ischemia (ALI). However there has been little evaluation of this pathology in the nonagenarians. The objectives of this work were thus to evaluate the one-month and one-year mortality of the nonagenarians treated for ALI, which made possible to determine the one-year survival and to highlight the factors influencing the mortality.
This was a monocentric retrospective study including all the patients aged 90 years old or more surgically treated for ALI between January, 2012 and December, 2016. In all the patients, we recorded the one-month mortality and the one-year survival and the demographic, the clinical and the paraclinical data.
We operated 83 nonagenarians, with a majority of women (59, 71.1%), using general anesthesia in 20 patients (16.6%), including 10 cases of upper limb acute ischemia (12.0%). The overall mortality rate at one month was 22.9%, and the one-year survival rate was 43.4%. Major amputation rate was 9.6% at one year. The survival of the patients operated for upper or lower limb ischemia was similar (p=0.82). Univariate analysis showed that the one-year survival was lower in patients having a history of cerebrovascular problems (p=0.0003), heart failure (p=0.0027), dementia (p=0.0452), or in patients that were institutionalized (p=0.0125), invalid (p=0.0001), or presented with a complete acute ischemia (p=0.0002). In multivariate analysis, three risk factors remained statistically significant: a previous history of cerebrovascular accident (HR= 3.05 [1.54-6.02]; p=0.0014), cardiac failure (HR= 2.21 [1.23-3.97]; p=0.0083) and complete AI (HR= 3.07 [1.64-5.75]; p=0.0005).
Our study showed that a history of cerebrovascular accident, cardiac failure or a complete AI are poor prognostic factors for the one-year survival of nonagenarians dealt operated for ALI. These elements should be taken into account when deciding either to operate or not in this precise context.
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