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Vascular: Peripheral Vascular Intervention Safe in the Elderly PAD Patient

There was high procedural and technical success and low rates of periprocedural complications

A recent study published in the Journal of the American College of Cardiology: Cardiovascular Interventions found that lower-extremity peripheral vascular intervention is safe and effective in elderly patients.

Peripheral artery disease (PAD) is a significant problem, especially in elderly people. Peripheral vascular intervention (PVI) is often preferred to surgical revascularization, as it is less invasive and is associated with lower overall morbidity. Little data existed regarding advanced age and PVI outcomes, so the authors of the current study used a multicenter PVI registry to investigate. They analyzed data from 7,769 PVI cases between January 2001 and December 2008. All patients had PAD confirmed by abnormal ankle brachial index, noninvasive imaging studies, or angiography. Patients were divided into one of three groups based on symptom severity—claudication, rest pain, or limb salvage—and age—younger than 70 years, between 70 and 80 years, or older than 80 years.

Mortality was very low in all age groups, and did not differ significantly. Advanced age did not appear to predict in-hospital adverse events, which surprised the authors because surgical revascularization is associated with higher risks in older patients. Patients 70 years and older were not more likely to have major adverse cardiac events, transfusion, amputation, or contrast-induced nephropathy than younger patients. They were more likely to have vascular access complications, however. Technical and procedural success rates were high in patients younger than 80 years (78 to 85 percent), but were lower in the oldest group. The authors conclude that “contemporary PVI can be performed in elderly patients with high procedural and technical success with very low overall incidence of adverse events and acceptably low mortality rates. These findings support the use of PVI as the preferred method of revascularization in the treatment of severe PAD in the elderly population.”

Source: Plaisance BR, Munir K, Share DA, et al. 2011. Safety of contemporary percutaneous peripheral arterial interventions in the elderly: insights from the BMC2 PVI (Blue Cross Blue Shield of Michigan Cardiovascular Consortium Peripheral Vascular Intervention) Registry. Journal of the American College of Cardiology: Cardiovascular Interventions 4(6):694-701.