ORIGINAL STUDIES Increased mortality in octogenarians treated for lifestyle limiting claudication Y. Erben, MD 1 | C. I. Mena-Hurtado 2 | S. M. Miller 3 | R. A. Jean 4,5 | B. J. Sumpio 4 | C. A. Velasquez 6 | H. Mojibian 7 | J. Aruny 7 | A. Dardik 1 | B. E. Sumpio 1 1 Section of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 2 Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 3 Warren Alpert Medical School at Brown University, Providence, Rhode Island 4 Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 5 National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut 6 CES University School of Medicine, Medellin, Antioquia, Colombia 7 Section of Vascular Interventional Radiology, Department of Radiology, Yale University School of Medicine, New Haven, Connecticut Correspondence Young Erben, MD, Section of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar Street, BB 204, New Haven, CT 06510. Email: young.erben@yale.edu Funding information CTSA, Grant/Award Number: TL1 TR001864 from the National Center for Advancing Translational Sciences (NCATS); National Institutes of Health (NIH) Abstract Objective: Treatment for lifestyle limiting claudication (LLC) that is due to infra-inguinal peripheral artery disease relies on either bypass, angioplasty, and/or stenting. Given the enthusiasm and shift toward more endovascular therapy for treatment of LLC, we sought to analyze whether octoge- narians benefit from infra-inguinal interventions in the same manner as their younger counterparts. Methods: We identified all patients admitted for elective treatment of LLC from the Nationwide Inpatient Sample from 2003 to 2012, who received open surgical or endovascular intervention for infra-inguinal peripheral arterial disease. These patients were divided into two groups including those between the ages 60–80 years (younger cohort) and those older than 80 years (octogenar- ians). Primary end-points included morbidity and mortality and the secondary end-points were length of hospital stay (LOS) and disposition after dismissal. Results: Among 59,323 discharges identified in the dataset, 34,658 (58%) were males. There were 50,323 (85%) patients in the younger cohort and 9,000 (15%) octogenarians. The mean age was 69.9 6 5.7 years and 84.2 6 3.0 years for the younger cohort and octogenarians, respectively. The mean Charlson comorbidity index (CCI) was higher in our younger cohort (2.1 6 1.1, P < 0.001). Octogenarians mainly treated with open surgery prior to 2004 are now treated endovascularly and this trend has remained stable. The younger cohort’s treatment modality has fluctuated through the study period and most recently is treated mainly with open surgery. The rate of acute kidney injury, exacerbation of congestive heart failure and mortality was higher in octogenarians (P < 0.001). The rate of infectious wound complications was higher in the younger cohort (P < 0.05). Octogenarians have longer LOS and are dismissed in higher percentage to a skilled nurs- ing facility (P < 0.001). On binary logistic regression analysis, age over 80 years, female sex, higher CCI and having an open as opposed to an endovascular procedure are independent predictors of in-hospital mortality. Conclusions: Although endovascular techniques seem to dominate the care for octogenarians with LLC, the overall morbidity and mortality rates are significantly higher in this patient popula- tion. Other options such as medical management and/or supervised exercise therapy should be explored in this patient group. KEYWORDS angiography, peripheral/renal, peripheral arterial disease, peripheral intervention, surgery, periph- eral vascular Catheter Cardiovasc Interv. 2018;1–8. wileyonlinelibrary.com/journal/ccd V C 2018 Wiley Periodicals, Inc. | 1 Received: 25 September 2017 | Accepted: 15 January 2018 DOI: 10.1002/ccd.27523