Interventional Revascularization in Elderly Patients with Peripheral Artery Disease: An Analysis of the RECCORD Registry

Background:
The prevalence of symptomatic lower extremity artery disease (LEAD) increases rapidly with age. The main approach for endovascular revascularization (EVR) in elderly patients is catheter-based therapy. The RECcording COurses of vasculaR Diseases (RECCORD) registry includes patients of all ages that underwent EVR in Germany. Scientific evidence concerning patient and procedure characteristics as well as outcome in elderly patients is still scarce.

Objective:
We analyzed data from the RECCORD registry to assess risk factors, symptoms and lesion characteristics as well as applied EVR treatment, complications and outcomes in elderly patients.

Methods:
The RECCORD registry is a prospective, multicenter database recruiting all-comers undergoing EVR for symptomatic PAD in Germany. It contains data on patients (e.g. age, sex, ABI, symptoms, risk factors, lesions), procedures and outcomes. For the evaluation of EVR therapy in elderly patients, we focused on the comparison of patients ≥ 80 years with younger patients.

Results:
A total of 7171 patients (mean age 72.3 ± 10.2 years, 35.4% female) with PAD that underwent 12.815 interventional revascularizations were analyzed. 1980 patients were aged 80 years and above (mean age 84.8 ± 3.9 years, 47.5% female). Regarding older patients, most common risk factor was arterial hypertension (89.2%) and leading symptom severity was Rutherford category 3 (33.7%). Of the 3747 intervened lesions, most were femoral (41.5%), stenotic (56.4%) and short (<10cm, 51.9%). Older patients had significantly more popliteal (25.1% vs. 15.2%, p<0.001) and below-the-knee (BTK, 20.6% vs. 10.4%, p<0.001) lesions in comparison to patients < 80 years. While use of EVR according to lesion type was mostly similar in younger and older patients, use of DCB angioplasty in popliteal lesions was more common in younger patients (55% vs. 59.7%, p=0.02). Access site complications were significantly more frequent in older patients (3.7% vs. 2.9%, p=0.04). Regarding outcomes, older patients had significantly more new amputations (4.9% vs. 3.6%, p=0.006) and higher mortality (7.5% vs. 2.6%, p<0.001).

Conclusion:
The RECCORD registry data demonstrate that elderly patients undergoing EVR have a higher Rutherford category, more popliteal and BTK lesions as well as more frequent stenotic and shorter lesions. Access site complications, new amputations and mortality were higher in older patients. This study highlights differences as well as similarities in the treatment of PAD in older vs. younger patients and emphasizes the importance of age-specific risk assessment in clinical decision-making.