SIR: Elderly Do Well in Arterial Procedures

By Michael Smith
WASHINGTON, March 18 -- There is no age limit for diagnostic angiography and percutaneous arterial procedures such as stenting, said researchers here.In a three-year single-center study, patients 80 or older had comparable safety outcomes to those ages 50 through 79, said George Hartnell, M.D., FRCP, of the Baystate Medical Center in Springfield, Mass. The findings indicate that diagnostic arteriography and percutaneous arterial interventions for peripheral vascular disease can be safely performed in older patients, Dr. Hartnell said at the Society of Interventional Radiology meeting.
Procedures for the octogenarians (mean age 85.1 years, range 80 to 93) included diagnostic arteriography (20), arterial angioplasty only (13), or arterial stent (31; 15 renal, 8 iliac, 15 infrainguinal).
"There is a perception that when you get very elderly," he said that many procedures "become more hazardous."
In the study, Dr. Hartnell recorded procedures and outcomes for consecutive patients 80 or older treated at his institution, and compared them with a contemporary cohort of those ages 50 to 79.
All told, 91 "very elderly" patients were treated over a 36-month period, along with 260 in the younger cohort.
Dr. Hartnell said diagnostic arteriography was more common in the younger cohort (43% versus 27%) while angioplasty or cryoplasty were more common in the elderly group (21% versus 10%).
Stenting, with or without angiography, was roughly equivalent, accounting for 51% in the elderly group and 46% in the younger cohort, he said.
Safety outcomes were almost identical, Dr. Hartnell said, with five adverse events in the elderly group (5.5% of the 91 cases) and 15 in the younger group (5.7% of 260 cases).
Major events were also similar, at 2.2% in the elderly group and 2.3% in the younger patients, he said.
There were no deaths in either group.
Dr. Hartnell added that the routine use of closure devices after the percutaneous procedures was not needed in either group.
He noted that the procedures were performed on an outpatient basis and that the elderly patients -- although often frail -- were sufficiently stable to be able to walk in and out of the office.
The bottom line, he said, is that the very elderly "seem to tolerate arteriography and arterial interventions as well as younger patients" and don't need to be hospitalized for the procedures.
The findings are "a very important dataset," commented Joshua Hirsch, M.D., of Massachusetts General Hospital, who moderated a press conference at which Dr. Hartnell discussed his results.
"There is a natural consensus that the elderly are sometimes best left alone," Dr. Hirsch said, but Dr. Hartnell's data imply that some at least can be treated safely.
"I do believe everything is about selection," Dr. Hirsch said. "If you select your patients properly then age becomes just one more variable in deciding whether it's appropriate to treat someone."
The study had no external support. Dr. Hartnell reported no conflicts.
Primary source: Journal of Vascular and Interventional RadiologySource reference:Hartnell GG "Outpatient arteriography and arterial intervention in octogenarians: Is it safe?" J Vasc Interv Radiol 2008; 19(2) Supplement S: Abstract 131.