Clinical study on the characteristics and treatment of critical limb ischemia caused by limb arteriosclerosis obliterans in elderly patients ≥ 70 years
10.3760/cma.j.jssn.1673-4904.2016.07.004
- VernacularTitle:70岁及以上老年下肢动脉硬化闭塞症患者严重肢体缺血特点与治疗的临床研究
- Author:
Bin LIU
- Publication Type:Journal Article
- Keywords:
Arteriosclerosis obliterans;
Aged;
Lower extremity;
Retrospective studies
- From:
Chinese Journal of Postgraduates of Medicine
2016;39(7):586-589
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the characteristic and optimal therapy of critical limb ischemia (CLI) caused by limb arteriosclerosis obliterans (ASO) in elderly patients ≥70 years. Methods The clinical and follow-up data of 122 elderly patients (≥ 70 years) with CLI caused by ASO were analyzed. The differences were compared between 70-79 years patients (67 cases) and 80- 91 years patients (55 cases). Results The time from onset to treatment in 80-91 years patients was significant longer than that in 70-79 years patients:(45 ± 15) d vs. (26 ± 10) d, the ratios Rutherford class 4-6 and Trans-Atlantic Inter-Society Consensus (TASC) Ⅱclass C-D lesions in 80-91 years patients were significantly higher than those in 70-79 years patients: 89%(49/55) vs. 67%(45/67) and 91%(61/67) vs. 100%(55/55), and there were statistical differences (P<0.01 or<0.05). The ankle arm index (ABI) after endovascular treatment in 70-79 years patients (37 cases) and 80- 91 years patients (22 cases) were significantly higher than those before treatment: 0.86 ± 0.05 vs. 0.40 ± 0.05 and 0.85 ± 0.05 vs. 0.39 ± 0.08, and there were statistical differences (P<0.05). There were no statistical differences in ABI of conservative treatment patients before and after treatment (P>0.05). The conservative treatment mortality in 80- 91 years patients was significantly higher than that in 70- 79 years patients: 29%(7/24) vs. 9%(2/23), and there was statistical difference (P<0.05). Ninety-five patients were followed up for 1-24 months, and the median was 15 months. Nine patients (7%) died within 30 d. In the first year of follow-up, 8 cases underwent amputation, 6 cases died, and 6 cases had stent thrombosis. In the second year of follow-up, 12 cases underwent amputation, and 18 cases died. The median survival time was 19 months. The mortality in conservative treatment patients was significantly higher than that in endovascular treatment patients:53%(19/36) vs. 24%(14/59), and there was statistical difference (P<0.05). The survival time in amputation patients had increasing trend, but there was no statistical difference (P>0.05). Conclusions The≥70 years elderly patients with CLI caused by ASO have more complications and longer time from onset to treatment, and the lesions are mainly Rutherford class 4-6 and TASC classⅡC-D. Endovascular treatment is difficult, but the effect is better than conservative treatment.
