Report from SIR: Octogenarians can safely undergo intra-arterial interventions

Tufts University researchers have found that patients aged 80 and older can tolerate intra-arterial diagnostic and interventional procedures, performed in outpatient settings, just as well as younger patients. The myth-busting results could dispel claims that extremely old patients are too frail to undergo such procedures.

Many studies in the medical literature suggest that the risks of percutaneous intra-arterial therapies increase as patients approach their ninth decade of life. Physicians often infer that certain procedures, such as angiography or angioplasty, are too risky for these patients.

But sound, credible data on the safety of these interventions in elderly patients are hard to come by, said principal investigator Dr. George Gordon Hartnell, chief of cardiovascular and interventional radiology at Tufts' Baystate Medical Center in Springfield, MA. Hartnell's prepared comments were presented March 18 at the 2008 Society of Interventional Radiology meeting in Washington, DC.

"In fact, some research protocols deliberately or unconsciously exclude the elderly from participation. And this means that some patients may be inappropriately denied treatment due to the perceived high risk in this age group," he said.

Based on three years of clinical experience, Hartnell examined data from 64 patients with a mean age of 85.1 years (range = 80 to 93) who underwent catheter-directed intra-arterial diagnoses and interventions. He compared their outcomes with those of 205 patients, aged 50 to 79, who underwent equivalent procedures.

Hartnell found most patients in the target group underwent the procedures safely, even without the need for closure devices, and that they don't need to be hospitalized to receive them.

Octogenarians underwent 20 diagnostic arteriographies, 13 arterial angioplasties, and 30 arterial stenting interventions (15 renal, eight iliac, 15 infrainguinal). Only three patients had complications, including one false aneurysm and three late hematomas. Follow-up revealed no admissions for complications were necessary after discharge. Two patients in the control group needed postprocedure admission, one for a large hematoma and one for worsening ischemia.

Relatives of elderly patients often express concern about the potential risk of such procedures, and physicians are frequently reluctant to recommend treatment. The study may help ease apprehensions, since it showed that what seems an appropriate treatment at 55 is also safe at age 85, Hartnell said.

The findings have important clinical implications, as the incidence of clogged arteries increases with age. Peripheral arterial disease already affects nearly a fifth of U.S. patients who are 65 and older, he said.

"Diagnostic arteriography and percutaneous arterial interventions can be safely performed as outpatient procedures," he said. "Contrary to what many people have said elsewhere, the rate of complications is low and the routine or frequent use of closure devices is not necessary."

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