Vascular procedures in nonagenarians and centenarians are safe.

BACKGROUND: An increasing number of elderly patients present for elective and emergent vascular procedures. The purpose of this study was to analyze the 30-day and long-term outcome of patients in their 10th decade of life undergoing vascular procedures. METHODS: We reviewed the outcomes of all patients in the 10th decade of life included in our registry. RESULTS: In a 15-year period, there were 176 patients, 102 women and 74 men, with a mean age of 92 (range 90-102) undergoing 196 vascular operations for acute and chronic limb ischemia, aortic and popliteal aneurysms, and carotid stenosis. Overall morbidity and mortality rates were comparable as well as the return to preoperative functional status. CONCLUSIONS: Patients in their 90s can safely undergo vascular procedures with reasonable early outcomes. Most patients return to their preoperative status. Age alone should not be a determinant in refusing surgery in this age group.

Complication rates for percutaneous lower extremity arterial antegrade access.

HYPOTHESIS: The antegrade access (AA) for percutaneous arterial interventions is associated with a higher complication rate than is the retrograde access (RA). DESIGN: Retrospective case review. SETTING: A statewide consortium for peripheral vascular interventions consisting of 13 Michigan hospitals collecting data on their endovascular procedures. PATIENTS: Demographic and procedure data on all patients receiving a percutaneous peripheral arterial intervention were entered prospectively by a full-time clinical nurse specialist in each hospital site. MAIN OUTCOME MEASURES: We evaluated vascular complications as a composite of retroperitoneal hematoma, pseudoaneurysm, hematoma requiring blood transfusion, arteriovenous fistula, acute thrombosis, or the need for surgical repair of the access site. RESULTS: In a 2-year period, we collected 6343 cases, of which 5918 had complete data regarding arterial access; of these, 745 (12.6%) were performed via an AA. There were fewer women and smokers (P < .001) in the AA group but more diabetic patients (P < .001). The indications for intervention were more frequently rest pain (P < .001) and limb salvage (P < .001) in the AA group. Multivariate regression analysis showed that the odds of complications were significantly higher with a larger sheath (95% confidence interval, 1.53-4.06; P < .001). Also, the incidence of blood transfusion and subsequent amputation was significantly higher in the AA group (P < .001). CONCLUSION: Endovascular procedures performed via an AA are more likely to result in perioperative complications and therefore should be used cautiously.

Carotid angioplasty and stenting versus redo endarterectomy for recurrent stenosis.

BACKGROUND: Carotid angioplasty and stent (CAS) is an alternative to redo carotid endarterectomy (RCEA) for recurrent carotid stenosis (RCS). The purpose of this study was to evaluate the outcomes of CAS in the treatment of RCS. METHODS: In an 8-year period, all patients presenting for treatment of RCS were followed-up prospectively. Logistic regression analysis was performed to identify variables associated with unfavorable outcomes. RESULTS: There were 45 CAS and 46 RCEA procedures performed in 75 patients. One patient in each group suffered a stroke. There were no deaths. The hospital length of stay was significantly shorter for CAS. Secondary recurrence was higher after RCEA (14% vs 6.1%) and failure to take beta-blockers was an independent predictor for multiple recurrences. CONCLUSIONS: CAS is a safe and effective method to treat patients with RCS and may become the procedure of choice for this disease.