Outcome of infrapopliteal bypass in the elderly

To review the published papers reporting on the use of infrapopliteal bypass in elderly patients (aged 70 years or more) in the treatment of critical limb ischaemia.

A MEDLINE (1966-2006) search for articles relating to the topic. Eight single centre studies were identified and in addition one population based study from Finland.

Perioperative mortality rate after infrapopliteal bypass surgery among elderly patients ranged from 2% to 12%. Patency and limb salvage rates were comparable to those reported in literature for younger patients. Data on survival rates were inconsistent. Several authors propose an active reconstruction policy in the elderly provided that a successful bypass procedure is likely to save the leg and improve the quality of life of these patients by maintaining ambulatory function and independent living at least for a year.

Despite a relatively short life expectancy, after successful revascularisation, the majority of elderly patients can be expected to spend their remaining years ambulatory and at home. The decision whether to reconstruct or amputate is always patient bound, taking into consideration different risk factors. Age alone should, however, seldom be a reason to decline infrapopliteal bypass.