# Clinical characteristics of extremely elderly versus normal elderly patients with chronic limb-threatening ischemia: a single-center real-event retrospective study

## TL;DR

This study finds that endovascular therapy for leg ischemia improves quality of life in very elderly patients, despite higher risks compared to younger elderly patients.

## Contribution

The study provides evidence that age alone should not disqualify elderly patients from endovascular therapy for chronic limb-threatening ischemia.

## Key findings

- Extremely elderly patients had more complex lesions and lower one-year freedom from major adverse limb events.
- Drug-coated balloons and lipid-lowering agents reduced the risk of adverse limb events.
- Both age groups showed comparable improvements in pain and function after treatment.

## Abstract

The benefit of endovascular therapy (EVT) for chronic limb-threatening ischemia (CLTI) in patients aged ≥ 80 years (extremely elderly) is debated. This study compared outcomes between extremely elderly and younger elderly (60–79 years) patients.

In this retrospective study, 367 patients (133 ≥ 80y, 234 60-79y) undergoing EVT were analyzed. Propensity score matching balanced baseline characteristics. Primary endpoints were one-year major adverse limb events (MALEs) and mortality. Univariate Cox analysis identified MALE-associated factors.

After matching, the ≥ 80y group had more complex lesions (longer occlusions, poorer runoff). Their one-year freedom from MALEs (44.721% vs 61.697%, p = 0.053) and freedom from mortality rates(77.191% vs 85.628%, p = 0.215) were lower. Univariate analysis indicated age ≥ 80y (HR = 1.55, 95% CI 1.01–2.38, P = 0.043) and TASC II C/D lesions (HR = 1.26, 95% CI 1.02–1.55, P = 0.035) increased MALE risk, while drug-coated balloons((HR = 0.69, 95% CI 0.56–0.85, P = 0.001).

and Lipid lowering agents usage (HR = 0.59, 95% CI 0.36–0.98, P = 0.041) were protective. Postoperative psychiatric symptoms were more frequent in the ≥ 80y group. Critically, both groups showed significant and comparable improvements in pain scores and functional capacity after EVT.

Despite higher risks, EVT meaningfully improves quality of life in extremely elderly CLTI patients. Treatment should not be denied based on age alone, but should be individualized considering the higher anatomical complexity.