Frailty and Critical Limb ischemia: Facing a New Challenge

Courtesy of Dr. Carlos Fava.

Critical limb ischemia is the final stage of peripheral vascular disease and is associated to pain at rest, trophic lesions, and gangrene. It is also associated to amputation and reduced mobility.

Angioplastia vs cirugía en isquemia crítica a largo plazoWhen it happens in frail patients, it presents a challenge. This population is on the rise and there is little information on its evolution.

 

The study looked at 643 patients with critical limb ischemia. 486 received PCI and 157 received surgery.

 

To assess frailty, researchers used the Canadian Study of Health and Aging Clinical Frailty Scale (CFS), and divided patients in 3 groups according to risk: low = 234 patients (36.2%), intermediate = 196 (30.3%) and high = 213 (33%).


Read also: What Is the Prognosis for Reinterventions in Critical Lower Limb Ischemia?


Mean age was 74.5 years, 60% were men, 68% diabetic, 50% were on dialysis. They were all Rutherford class 4, 5, or 6. Half of them presented trophic lesions, more often those at high risk. Age and BMI ≤21 was higher in the high-risk group.

 

AT 2 year follow up, survival rate was 80.5% for the low risk group, 63.1% for the intermediate risk group, and 49.3% (p<0.001) for the high-risk group. Survival free of amputation was 77.9%, 60.5%, and 46.2% (P<0.001) for the low, intermediate and high-risk groups, respectively.

On multivariable analysis, frailty risk was independently associated with all-cause mortality (intermediate group: adjusted hazard ratio, 1.64; 95% confidence interval, 1.12-2.42; P=0.01; high CFS group: adjusted hazard ratio, 2.22; 95% confidence interval, 1.52-3.23; P<0.001) and the composite of all-cause mortality and major amputation (intermediate risk group: adjusted hazard ratio, 1.72; 95% confidence interval, 1.19-2.48; P=0.004; high risk group: adjusted hazard ratio, 2.34; 95% confidence interval, 1.64-3.35; P<0.001).


Read also: Lesion Targeting Seems to Be the Secret in Critical Ischemia.


In addition, frailty was independently associated to all-cause mortality and major amputation of patients >75 and <75 years, regardless of PCI or surgery and regardless renal function.

 

Conclusion

At 2 year follow up, frailty was independently associated to survival and survival free of amputation in patients with critical limb ischemia treated with revascularization, regardless age, type of revascularization and kidney function.

 

Commentary

These findings show us that frailty itself, as risk factor, presents bad evolution at 2 years in terms of mortality and major amputation, showing a direct correlation with patient risk.

 

As we know, at present, this population is growing, and it presents a challenge, given that most times aggressive intervention is not recommended, since it would increase periprocedural complications.

 

Courtesy of Dr. Carlos Fava.

 

Original title: Impact of Frailty on Clinical Outcomes in Patients With Critical Limb Ischemia

Reference: Yasuaki Takeji, et al. Circulation: Cardiovascular Interventions. 2018;11:e006778


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

STRIDE: Semaglutide in Patients with Peripheral Arterial Disease and Type II Diabetes

Peripheral arterial disease (PAD) is a severe complication in patients with type II diabetes, primarily affecting peripheral vessels, especially below-the-knee (BTK) arteries. This condition...

IVUS-Guided vs. Angiography-Guided Drug-Coated Balloon Angioplasty in the Treatment of Femoropopliteal Lesions

Angiography has traditionally been the primary imaging technique for endovascular therapy guidance in patients with peripheral artery disease. However, as it only provides two-dimensional...

New Carotid PCI All-in-One System

Carotid stenting is equivalent to carotid endarterectomy in terms of major adverse events (death, AMI, and stroke). However, it entails higher risk of minor...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

STRIDE: Semaglutide in Patients with Peripheral Arterial Disease and Type II Diabetes

Peripheral arterial disease (PAD) is a severe complication in patients with type II diabetes, primarily affecting peripheral vessels, especially below-the-knee (BTK) arteries. This condition...