Outpatient arterial procedures found safe for octogenarians.

WASHINGTON -- Contrary to common belief, octogenarians can safely undergo diagnostic arteriography and arterial interventions as outpatient procedures.

That was the conclusion of a retrospective comparison of outpatient arterial procedures performed over 36 months (2005-2007) in 91 patients aged 80 years and above (mean 83.8) with those of 260 patients done in adults aged 50-79 years (mean 67.6) during the same time period by Dr. George G. Hartnell.

"Octogenarians seem to tolerate arteriography and arterial interventions as well as younger patients," Dr. Hartnell, who is chief of cardiovascular and interventional radiology of Baystate Medical Center in Springfield, Mass., said at the annual meeting of the Society of Interventional Radiology.

The risks of diagnostic arteriography and arterial interventions are believed to increase with age. Some have suggested that patients in their 80s and older who require such procedures should be automatically admitted to the hospital, but it appears likely that in many cases, the procedures aren't offered to the very elderly at all. "Octogenarians may be inappropriately denied treatment because of the perceived high risk," he said.

Because of that bias, octogenarians often are excluded--de-liberately or unconsciously--from clinical trials of these procedures, so there is no database to guide interventionalists. "There should be more use of these procedures in the elderly, but data are lacking," Dr. Hartnell remarked.

During the study period, 27% of the octogenarians underwent diagnostic arteriography (10 renal, 14 femoral, and 1 carotids/upper-extremity procedures), as did 43% of the 50- to 79-year-old patients (30 renal, 46 femoral, 31 carotids/UE, and 7 mesenteric procedures).

Angiography/cryoplasty was performed in 19 octogenarians (21%) and 26 of the younger adults (10%). Stenting, with or without angioplasty, "was done in 46 (51%) of the octogenarians (9 multivessel) and in 119 (46%) of the 50- to 79- year-olds (34 multivessel).

Patients of all ages were treated the same way, with closure devices used in fewer than 2% of all the interventions. "The routine or frequent use of closure devices is not necessary," Dr. Hartnell commented.

The fact that the proportion of patients who underwent diagnostic arteriography was significantly lower among the 80-plus group (27% vs. 43%) probably reflects the bias that "they just don't get referred," he said.

Reported rates of complications in the two age groups were very similar. Total events occurred in 5.5% of the octogenarians and 5.7% of the younger cohort, and major events requiring hospital admission in 2.2% and 2.3%, respectively. Worsening ischemia occurred in one younger patient and none of the older ones. There was one hematoma requiring admission among the octogenarians and two in the 50- to 79-year-olds, while hematomas of greater than 3 cm requiring no action occurred in three of the older group (3.3%) and six (2.3%) of the younger group. Heart failure developed in one younger patient and none of the older ones, and there were no deaths in either group, Dr. Hartnell reported.

These complication rates fall within the thresholds set by the Society of Interventional Radiology, which include an overall diagnostic arteriography threshold for major complications of no more than 1% (J. Vasc. Interv. Radiol. 2003;14:S283-8).

Among the society's upper limits for complications from percutaneous renal revascularization are 1% for 30-day mortality, 2% for renal artery occlusions and acute renal failure, and 5% for access site hematomas requiring surgery, transfusion, or prolonged hospital stay (J. Vasc. Interv. Radiol. 2003;14:S219-21).

BY MIRIAM E. TUCKER

Senior Writer