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Acute limb ischemia in nonagenarians
G Galzerano1, G de Donato, F Setacci
1Department of Medical, Surgical and Neurosciences Unit of Vascular and Endovascular Surgery University of Siena, Siena, Italy. galzerano.giuseppe@gmail.com
The Journal of Cardiovascular Surgery
|September 5, 2013
Summary
Early revascularization for acute limb ischemia (ALI) in patients over 90 is safe and effective. Fogarty embolectomy demonstrates good outcomes, with low mortality and amputation rates in this elderly population.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Critical Care Medicine
Background:
- Acute limb ischemia (ALI) carries significant risks of limb loss and mortality, particularly in elderly patients.
- Outcomes for ALI are often worse in the geriatric population, necessitating specialized treatment strategies.
Purpose of the Study:
- To evaluate the safety and efficacy of early revascularization in patients aged 90 years and older with ALI.
- To quantify the outcomes of emergent surgical intervention for ALI in the very elderly.
Main Methods:
- Prospective registry study conducted from January 2012 to January 2013.
- Included 15 consecutive patients over 90 years old treated for ALI.
- Utilized Duplex scan for preoperative assessment and Fogarty embolectomy, with optional endovascular completion.
Main Results:
- 18 revascularizations were performed in 15 patients, achieving 88.9% technical success.
- One-year outcomes included 76.5% freedom from death, 88.2% freedom from amputation, and 71.3% freedom from re-occlusion.
- In-hospital mortality was 5.9% and amputation rate was 6.2%.
Conclusions:
- Patients over 90 present a significant challenge in vascular surgery due to high procedural risks.
- Emergent revascularization using Fogarty Embolectomy for ALI is a safe and effective treatment option, even in the oldest patients.
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