Statewide study shows interventions are successful in the elderly despite more severe peripheral arterial disease
ANN ARBOR, Mich. – A new study led by the University of Michigan Cardiovascular Center shows that it is safe for the elderly to undergo minimally invasive procedures to treat a common circulation problem.
Like clogged arteries in the heart, a build-up of plaque can affect circulation in the legs and limit the ability to exercise or even walk and sometimes lead to amputation.
The restricted blood flow is known as peripheral arterial disease, or PAD, and more than 4 million American adults, nearly 15 percent of those over age 70, have the vascular disease.
U-M researchers and colleagues in the Michigan Cardiovascular Consortium showed elderly patients were no more likely than younger patients to suffer major complications or deaths after endovascular procedures such as angioplasty or stents to restore blood flow in the lower extremities.
“A patient’s age may not be the significant predictor of whether they’ll experience complications from the endovascular procedures,” says study lead author P. Michael Grossman, M.D., an interventional cardiologist at the University of Michigan Cardiovascular Center.
“Patients with PAD of the legs can be quite impaired, but after these procedures, these patients can experience improvements in their quality of life,” he says.
The severity and location of blockages may determine whether doctors use a less invasive endovascular procedure or open surgery to treat PAD. But the study supports the ‘endovascular-first approach’ that’s emerging in medical care, particularly for older patients who often have other medical conditions that may increase the risk of major complications associated with open surgery.
Authors write that “the findings may support the notion of using peripheral vascular interventions as a preferred … strategy in the treatment of severe PAD in the elderly.”
Data from 18 Michigan hospitals was used in the research published in the Journal of the American College of Cardiology: Cardiovascular Interventions.
The hospitals are part of the Blue Cross Blue Shield of Michigan Cardiovascular Consortium Peripheral Vascular Intervention, a statewide collaborative effort focused on improving patient safety and quality of care. The U-M is the coordinating center for the consortium and its registry of patients who have had vascular interventions at Michigan hospitals.
In this study, 7,779 patients with PAD were divided into three age groups: less than 70 years old, 70 to 80 years old, and 80 years and older. Endovascular interventions were mostly successful despite more severe PAD.
Technical success was highest in the youngest age group – 85 percent compared to 82 percent among 70 to 80-year-olds and 78.2 percent in those over 80 years old. But older age was not associated with an increased risk of major complications such as death, heart attack, stroke, transfusion, or amputation.
PAD can develop as a result of smoking, diabetes, , elevated cholesterol, hypertension, obesity or a family history of cardiac or vascular disease. Some patients have no symptoms. But for others, PAD can cause severe leg pain and numbness and be a limb- or even life-threatening condition.
The U-M Multidisciplinary PAD program delivers care with a team of experts from interventional cardiology, interventional radiology, cardiovascular medicine, vascular medicine and vascular surgery. The PAD program uses traditional therapies like lifestyle changes and medications as well as special procedures and surgeries to provide relief for patients and reduce their risk for heart attack and stroke.
Additional authors: Benjamin R. Plaisance, M.D., University of Michigan Division of Cardiovascular Medicine and the Ann Arbor VA Healthcare System; Khan Munir, Ph.D., U-M; David A. Share, M.D., U-M Department of Family Medicine; M. Ashraf Mansour, M.D., Spectrum Health; James M. Fox, M.D., Munson Medical Center; Paul G. Bove, M.D., William Beaumont Hospital; Arthur L. Riba, M.D., Oakwood Hospital and Medical Center; Stanley J. Chetcuti, M.D., U-M and Ann Arbor VA; and Hitinder S. Gurm, M.D., U-M and Ann Arbor VA.
Reference: “Safety of contemporary percutaneous peripheral arterial interventions in the elderly,” Journal of the American College of Cardiology: Cardiovascular Interventions, Vol. 4, No. 6.
Funding: Blue Cross Blue Shield Michigan, National Institutes of Health
University of Michigan Cardiovascular Center
Blue Cross Blue Shield Michigan Cardiovascular Consortium Peripheral Vascular Intervention
Written by Shantell M. Kirkendoll