Results of revascularization operations in geriatric patients with multifocal atherosclerosis

Background. Multifocal atherosclerosis (MFA) is one of the common diseases in elderly patients. Currently, there is no single approach to treating patients with MFA. The active implementation of endovascular surgery has significantly expanded the treatment options for comorbid elderly patients with MFA. Objective of the study: to evaluate the effectiveness and safety of various methods of surgical revascularization in geriatric patients with multifocal atherosclerosis. Materials and methods. This single-center observational cohort study was conducted in the Department of Cardiovascular Surgery at the Research and Clinical Center of the Russian National Research Medical University named after N.I. Pirogov. The study included 44 elderly patients with arterial diseases of various localizations. Two groups of patients were identified depending on the chosen treatment method: a group of patients undergoing endovascular treatment (n=30), and a group after open surgical procedures (n=14). Endovascular interventions: balloon angioplasty and/or stenting (carotid, iliac-femoral, popliteal-tibial, etc.), aortic endoprosthetic replacement (EVAR/TEVAR), endovascular reconstructions of visceral/renal arteries. Open surgeries: carotid endarterectomy, aortic prosthetic replacement/grafting/shunting, peripheral shunting, thromboendarterectomy, etc. All operations were performed as part of the routine schedule from June 2024 to June 2025. The choice of revascularization method was made by a multidisciplinary team. Results. An analysis of in-hospital complications was performed in 44 patients; no fatal cases were recorded during hospitalization. Postoperative delirium developed in 3 patients (2 in the endovascular treatment group and 1 in the open surgery group, p>0.05). Despite the less favorable initial geriatric and functional profile of patients undergoing endovascular surgery, early postoperative outcomes are comparable to the results in the group of patients who underwent open vascular surgery. To definitively assess the comparative effectiveness of treatment methods, larger-scale studies are needed, with careful adjustment for confounding factors, standardized collection of functional and patient-oriented outcomes, and analysis of long-term treatment results. Conclusion. Thus, with comparable risks of complications in elderly patients in the vascular surgery department with MFA and atherosclerotic lesions in various arterial territories, endovascular surgery allows for the operation of more “fragile” patients.