Infrainguinal reconstruction in octogenarians: should age be a contraindication?
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Published on: June 6, 2025
D Choi1, R C Darling, S P Roddy
1Institute for Vascular Health and Disease, Albany Medical College, Albany, NY 12208, USA.
Insights
Elderly patients over 80 undergoing infrainguinal reconstruction have outcomes comparable to younger patients. Age should not be a contraindication for this vascular surgery, ensuring appropriate patient care.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Health Economics
Background:
- Increasing demand for elderly medical care due to population aging.
- Healthcare cost containment pressures leading to denial of expensive procedures.
- Infrainguinal reconstructions denied based on age alone at the institution.
Purpose of the Study:
- To evaluate outcomes of infrainguinal reconstruction in octogenarians (aged >80 years).
- To compare results of elderly patients with younger cohorts.
- To determine if age alone is a valid contraindication for infrainguinal reconstruction.
Main Methods:
- Retrospective review of 629 patients aged >80 years undergoing infrainguinal reconstruction (1989-1998).
- Comparison with 3257 patients <80 years old during the same period.
- Analysis of demographics, indications, and outcomes using Fisher's exact test and log rank analysis (p < 0.05).
Main Results:
- Indications differed: more limb salvage (older group) vs. claudication (younger group).
- Similar nonfatal complication rates between age groups.
- Comparable primary and secondary patency rates and limb salvage rates for both octogenarians and younger patients.
Conclusions:
- Octogenarians achieve outcomes comparable to younger patients undergoing infrainguinal reconstruction.
- Age should not be an absolute contraindication for infrainguinal arterial reconstruction.
- Healthcare resources can be effectively allocated to octogenarian patients for this procedure.
Abstract:
With the graying of America comes an increasing demand for medical care of the elderly. Unfortunately, due to a combination of rising costs of health care and driving force from the public to lower spending, health maintenance organizations and insurance companies are less willing to pay for expensive surgical procedures. Recently, infrainguinal arterial reconstructions have been denied at our institution solely on the basis of patient's age, without adequate assessment of data. We evaluated the results of patients aged over 80 years who underwent infrainguinal reconstruction and compared them to results of younger cohorts during the same time period. From 1989 to 1998, 629 octogenarians had infrainguinal reconstructions performed at our institution. In the same time period, 3257 procedures were performed on patients <80 years old. Demographics, indications for operations, and outcomes were compared. Statistical analysis was performed with Fisher's exact test and log rank analysis, assuming significance for p < 0.05. Indications for operation were significantly more often limb salvage and less often claudication in the older group. Nonfatal complication rates were similar. Primary and secondary patency rates as well as limb salvage rates were comparable in both groups. Patients who are >80 years of age should expect comparable outcomes to those of their younger cohorts when undergoing infrainguinal reconstructions. Health care dollars can be well spent on octogenarians and age should not be a contraindication for infrainguinal reconstruction.
