Safety and Technical Effectiveness of Endovascular Intervention in Nonagenarians with Critical Limb Ischemia

Purpose: To determine intraoperative success and safety of mechanical atherectomy,  angioplasty, or both for nonagenarians in treatment of iliac and infrainguinal critical limb ischemia (CLI)

Materials and Methods: An institutional review board–approved, single-institution retrospective study was performed of nonagenarians (age, 90 years) undergoing mechanical atherectomy, angioplasty, or both for CLI secondary to iliac and infrainguinal atherosclerotic disease between October 2012 and June 2018. Patient demographics; medical history; and procedural characteristics and outcomes, including lesion characteristics, devices used, technical success, and acute complications, were recorded. The primary efficacy endpoint, technical success, was the achievement of a postintervention residual diameter stenosis 50% (before adjunctive therapy). The primary safety endpoint was the intraprocedural complication rate.

Results: A total of 42 patients (29 women, 13 men) with an average age of 92.4 years underwent a total of 57 procedures, which included 93 standard angioplasties, 29 orbital atherectomies, 2 directional atherectomies, 6 aspiration thrombectomies, and 4 laser atherectomies performed on 96 total lesions. Six drug-coated stents and 32 non–drug-coated stents were deployed. A total of 85.9% (n = 49) of procedures were successful, with failure to cross the lesion in 6 cases and more than 50% residual diameter stenosis in 2 cases. Procedural complications included 10 dissections (10.4%, n = 96) of which six were flow-limiting and required endovascular stent placement. There were 4 total intraoperative distal embolizations, 2 occurring with standard angioplasty, 1 with laser atherectomy without distal protection device, and 1 with combined angioplasty and orbital atherectomy with distal protection. There were no procedural-related deaths during the immediate periprocedural time period.

Conclusions: Atherectomy or angioplasty (or both) is a safe and well-tolerated procedure in nonagenarians with CLI. Further research is needed to determine the long-term efficacy of endovascular arterial intervention in this age group.