Age is Associated With Increased Mortality but Not Other Complications in Patients Undergoing Catheter-directed Arterial Thrombolysis for Acute Lower Extremity Ischemia

Catheter-directed arterial thrombolysis (CDAT) has become a mainstay for the treatment of acute lower extremity ischemia (ALI). Although CDAT can be effective therapy, its use in older patients (>80 years) is considered a relative contraindication due to concern for complications. We evaluated short-term clinical outcomes of patients undergoing CDAT for ALI stratified by age. Patients with ALI undergoing CDAT between 2011 and 2021 were identified using the TriNetX Analytics Network, a federated network of nationwide health care organizations that provides de-identified patient data. The cohort was stratified by age (40-59, 60-79, and 80+ years) and analyzed by those receiving post-procedural tPA infusion and those not (itPA+ or itPA−). Outcomes included mortality, myocardial infarction (MI), amputation, acute blood loss, and reintervention. One-year outcomes were analyzed after propensity matching for demographics, comorbidities, and medications. After 1:1 propensity matching, there were significantly higher rates of mortality in the 60 to 79/itPA− group compared with the 40 to 59/itPA− group (8.7% vs 4.5%; P = .0020) and significantly higher rates of amputation in the 40 to 59/itPA− group compared with the 60 to 79/itPA− group (27.5% vs 22.6%; P = .0425). There were significantly higher rates of mortality in the 80+ group compared with the 40 to 59 group when stratifying in both itPA− (17.3% vs 4.1%; P < .0001) and itPA+ patients (18.0% vs 7.8%; P = .0153). There were also significantly higher rates of mortality in the 80+ group compared with the 60 to 79 group when stratifying in both itPA− (19.5% vs 9.0%; P < .0001) and itPA+ patients (16.7% vs 8.0%; P = .0043). Amputation rates in the 80+/itPA+ group were significantly higher compared with the 60 to 79/itPA+ group (28.1% vs 20.2%; P = .0488); there were similar rates of amputation in the 60 to 79/itPA− and 80+/itPA− groups. In patients undergoing CDAT for ALI there were higher rates of 1-year mortality in the 80+ patient group regardless of itPA status. Although there were significantly higher rates of 1-year mortality in 60 to 79/itPA− patients compared with 40 to 59/itPA− patients, mortality rates were similar in itPA+ patients. Complication rates were similar across all groups regardless of itPA status, apart from significantly higher 1-year amputation rates in 80+/itPA+ patients compared with 60 to 79/itPA+ patients. Older age is associated with increased mortality rates in patients undergoing CDAT for ALI. We found no association between increasing age and other postoperative complications.