Endovascular interventions may save limbs in elderly subjects with severe lower extremity arterial disease

Endovascular intervention,such as percu-taneous transluminal angioplasty(PTA),improves claudication and saves limbs of patients with severe lower extremity arterial dis-ease(LEAD).[1]A previous study showed that the mortality among octogenarians was as high as 29%regardless of the type of intervention and that re-vascularization was associated with high peripro-cedural mortality.[2]A previous study had already shown that reconstructive surgery for elderly indi-viduals over 80 years old resulted in a significantly higher mortality rate than that for patients between 70 and 80 years old,whereas endovascular inter-vention and primarily conservative treatment had comparable prognoses.[3]Consistently,another study showed that the risks of both overall and am-putation-free survival were significantly lower with endovascular treatment than with bypass surgery in patients with critical limb ischemia.[4]A systematic review and meta-analysis of 27 studies(15 cohort and 12 randomized controlled trials)with 1642 pa-tients suggests that conservative treatment may be considered for nonreconstructable patients with critical limb ischemia;[5]however,because a high risk of bias and serious inconsistencies were found in the included studies,the meta-analysis provided low-quality evidence.In contrast,a small cohort study with 49 patients suggests that amputation im-proved quality of life and health status in fragile elderly individuals.