Long-term risk of adverse limb outcomes in older patients after endovascular femoral artery revascularization: The Boston femoral artery endovascular revascularization outcomes (Boston FAROUT) study

Introduction: Older patients may be denied endovascular revascularization of the superficial femoral artery (SFA) for peripheral artery disease (PAD) due to concerns of worse limb outcomes than younger patients.

Methods: We assessed adverse outcomes in patients after an index revascularization stratified by age (age < 65, 65-75 years, and > 75 years) from two centers between 2003 and 2011 and followed a median 9 (25 %-75 %: 7, 11) years. Outcomes included major adverse limb events (MALE) or minor repeat revascularization, death, and major adverse cardiac and cerebrovascular events (MACCE). We used cause-specific and competing-risks analyses with clustering by patient to determine the hazard ratios (HR), sub-hazard ratios (SHR), 95 % confidence intervals (95%CI) for outcomes according to older age.

Results: There were 253 limbs revascularized in 202 patients with a high use of lipid lowering therapy (91 %) and aspirin anti-platelet therapy (96 %). In oldest age group (>75 years), 71 limbs were revascularized and patients were less likely to be active smokers and had poorer tibial runoff than younger patients. In competing risks multivariable models, patients >75 years old had similar risks over 10 years of MALE or minor revascularization (SHR = 0.92, 95%CI = 0.53, 1.62) and MACCE (SHR = 1.12, 95%CI = 0.58, 2.18) to younger patients. All-cause death was more common in older patients (HR = 1.99, 95%CI = 1.25, 3.17).

Conclusions: After adjusting for the competing risk of death, patients >75 years had similar incidence of adverse limb outcomes and MACCE to younger patients after endovascular revascularization of the femoral artery. Consequently, older patients should be considered for endovascular revascularization when indicated.