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Younger patients have worse outcomes after peripheral endovascular interventions for suprainguinal arterial occlusive disease.

Authors
  • Madigan, Michael C1
  • Farber, Alik2
  • Rybin, Denis V3
  • Doros, Gheorhge3
  • Robinson, William P 3rd4
  • Siracuse, Jeffrey J2
  • Eldrup-Jorgensen, Jens5
  • Eslami, Mohammad H6
  • 1 Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical School, Pittsburgh, Pa.
  • 2 Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, Mass.
  • 3 Department of Biostatistics, Boston University School of Public Health, Boston, Mass.
  • 4 Division of Vascular Surgery, East Carolina University Brody School of Medicine, Greenville, NC.
  • 5 Division of Vascular Surgery, University of Maine Medical School, Portland, Me.
  • 6 Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical School, Pittsburgh, Pa. Electronic address: [email protected]
Type
Published Article
Journal
Journal of vascular surgery
Publication Date
May 01, 2021
Volume
73
Issue
5
Pages
1715–1722
Identifiers
DOI: 10.1016/j.jvs.2020.08.139
PMID: 32987148
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The choice of intervention for treating suprainguinal arterial disease, open bypass vs endovascular intervention, is often tempered by patient age and comorbidities. In the present study, we compared the association of patient age with 1-year major adverse limb events (MALE)-free survival and reintervention-free survival (RFS) rates among patients undergoing intervention for suprainguinal arterial disease. The Vascular Quality Initiative datasets for bypass and peripheral endovascular intervention (PVI; aorta and iliac only) were queried from 2010 to 2017. The patients were divided into two age groups: <60 and ≥60 years at the procedure. Age-stratified propensity matching of patients in bypass and endovascular procedure groups by demographic characteristics, comorbidities, and disease severity was used to identify the analysis samples. The 1-year MALE-free survival and RFS rates were compared using the log-rank test and Kaplan-Meier plots. Proportional hazard Cox regression was used to perform propensity score-adjusted comparisons of MALE-free survival and RFS. A total of 14,301 cases from the Vascular Quality Initiative datasets were included in the present study. Propensity matching led to 3062 cases in the ≥60-year group (1021 bypass; 2041 PVI) and 2548 cases in the <60-year group (1697 bypass; 851 PVI). In the crude comparison of the matched samples, the older patients undergoing bypass had had significantly greater in-hospital (4.6% vs 0.9%; P < .001) and 1-year (10.5% vs 7.5%; P = .005) mortality compared with those who had undergone endovascular intervention. The rates of MALE (7.5% vs 14.3%; P < .001) and reintervention (6.7% vs 12.7%; P < .001) or death were significantly higher for the younger group undergoing PVI than bypass at 1 year. However, the rates of MALE (12.9% vs 14.3%; P = .298) and reintervention (12.7% vs 12.9%; P = .881) or death for were similar both procedures for the older group. Both log-rank analyses and the adjusted propensity score analyses of MALE-free survival and RFS in the two age groups confirmed these findings. The adjusted comparison of outcomes using propensity score matching favored PVI at 1-year survival (hazard ratio, 1.4; 95% confidence interval, 1.1-1.9; P = .003) for the older group but was not different for the younger group (hazard ratio, 0.6; 95% confidence interval, 0.3-1.0; P = .054). Among the patients aged <60 years undergoing intervention for suprainguinal arterial disease, the choice of therapy should be open surgical intervention given the higher risk of reintervention and MALE with endovascular intervention. Endovascular intervention should be favored for patients aged ≥60 years because of reduced perioperative mortality. Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

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