{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T08:34:56Z","timestamp":1781858096693,"version":"3.54.5"},"reference-count":21,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2022,5,4]],"date-time":"2022-05-04T00:00:00Z","timestamp":1651622400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,5,4]],"date-time":"2022-05-04T00:00:00Z","timestamp":1651622400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2022,5,4]],"date-time":"2022-05-04T00:00:00Z","timestamp":1651622400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>As a result of the increasing life expectancy of the western population, the number of older patients with chronic limb\u2010threatening ischemia (CLTI) seeking medical care is growing. Our objective was to describe the characteristics of a consecutive series of nonagenarian patients with CLTI and evaluate the outcomes of their management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>Retrospective analysis of a consecutive series of nonagenarian patients with CLTI attended at our institution between 2005 and 2019. Primary endpoints were 1\u2010year limb salvage and survival rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 171 patients were included (mean age 92.7, 51.5% women), of which in 59 (34.5%) primary major amputation (<jats:italic>n<\/jats:italic>\u2009=\u200910) or palliative care (<jats:italic>n<\/jats:italic>\u2009=\u200949) was indicated at presentation because of severe dementia (<jats:italic>n<\/jats:italic>\u2009=\u200930, 50.8%), knee retraction (<jats:italic>n<\/jats:italic>\u2009=\u200917, 28.8%), terminal condition (<jats:italic>n<\/jats:italic>\u2009=\u200913, 22%) or a non\u2010salvageable foot (<jats:italic>n<\/jats:italic>\u2009=\u200928, 47.4%). In the remaining 112 (65.5%), the need for a revascularization was further assessed finally performing A) conservative treatment\/minor amputation (<jats:italic>n<\/jats:italic>\u2009=\u200957, 50.9%), B) revascularization (<jats:italic>n<\/jats:italic>\u2009=\u200950, 44.6%) or C) direct major amputation (<jats:italic>n<\/jats:italic>\u2009=\u20095, 4.4%), with 1\u2010year limb salvage and survival rates of 93.1 and 57.4%, respectively. Predictive factors for lower survival included age\u2009&gt;92 years (HR\u2009=\u20091,59, <jats:italic>p<\/jats:italic>\u2009=\u20090.041), hemoglobin\u2009&lt;10.5\u00a0mg\/dL (HR 2,34, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), congestive heart failure (HR\u2009=\u20091.65, <jats:italic>p<\/jats:italic>\u2009=\u20090.036), non\u2010severe dementia (HR 3,11, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and current mobility with wheelchair (HR 1,74, <jats:italic>p<\/jats:italic>\u2009=\u20090.014).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Nearly one\u2010third of nonagenarian patients with CLTI have a direct indication for amputation or palliative care at presentation. In the remaining, a judicious approach with conservative treatment, minor amputation or revascularization procedures yields excellent limb salvage rates. Survival is, however, the cornerstone of these patients. It can be predicted with certain clinical factors which may help decision\u2010making.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-022-06570-5","type":"journal-article","created":{"date-parts":[[2022,5,4]],"date-time":"2022-05-04T14:02:49Z","timestamp":1651672969000},"page":"2825-2831","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Critical Limb Ischemia in Nonagenarians: A Challenge of Our Times"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3699-5885","authenticated-orcid":false,"given":"Eduard","family":"Casajuana Urgell","sequence":"first","affiliation":[{"name":"Department of Vascular and Endovascular Surgery Hospital del Mar Passeig Mar\u00edtim 25\u201029 08003 Barcelona Spain"},{"name":"Department of Surgery Universitat Aut\u00f2noma de Barcelona Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Calsina Juscafresa","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery Hospital del Mar Passeig Mar\u00edtim 25\u201029 08003 Barcelona Spain"},{"name":"Department of Medicine and Surgery Universitat Pompeu Fabra Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lluis","family":"Nieto Fernandez","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery Hospital del Mar Passeig Mar\u00edtim 25\u201029 08003 Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena","family":"Romero Monta\u00f1a","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery Hospital del Mar Passeig Mar\u00edtim 25\u201029 08003 Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carme","family":"Llort Pont","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery Hospital del Mar Passeig Mar\u00edtim 25\u201029 08003 Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Clar\u00e0 Velasco","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery Hospital del Mar Passeig Mar\u00edtim 25\u201029 08003 Barcelona Spain"},{"name":"Department of Medicine and Surgery Universitat Pompeu Fabra Barcelona Spain"},{"name":"CIBER Cardiovascular Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,5,4]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"113","article-title":"Taxation and life expectancy in Western Europe","volume":"12","author":"Bagger PJ","year":"2004","journal-title":"Cent Eur J Public Health"},{"issue":"1329","key":"e_1_2_6_3_1","first-page":"40","article-title":"Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis","volume":"382","author":"Fowkes FG","year":"2013","journal-title":"Lancet"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2014.03.290"},{"key":"e_1_2_6_5_1","first-page":"663","article-title":"Meta\u2010analysis of the prevalence, incidence and natural history of critical limb ischemia","volume":"54","author":"Biancari F","year":"2013","journal-title":"J Cardiovasc Surg"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.23736\/S0392\u20109590.18.03996\u20102"},{"key":"e_1_2_6_7_1","unstructured":"United Nations Department of Economic and Social Affairs Population Division Population Estimates and Projections Section.World Population Prospects the 2010 Revision. 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