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Limb salvage in the elderly.

R F McLoughlin1, L P Fitzgerald, J A O'Donnell

  • 1Department of Surgery, University College, Cork, Ireland.

Annals of Vascular Surgery
|January 1, 1989
PubMed
Summary
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Reconstructive surgery for severe lower limb ischemia in patients over 75 years old shows a 77% limb salvage rate. Despite challenges, elderly patients benefit from these procedures, with many retaining a viable limb at death.

Area of Science:

  • Vascular Surgery
  • Geriatric Medicine
  • Ischemia Research

Background:

  • Severe lower limb ischemia poses significant risks for elderly patients.
  • Reconstructive surgery is a potential treatment option, but outcomes in the very elderly require careful evaluation.

Purpose of the Study:

  • To evaluate the outcomes of lower extremity bypass procedures in patients aged 75 and older with severe lower limb ischemia.
  • To determine the feasibility and effectiveness of reconstructive surgery in this high-risk demographic.

Main Methods:

  • Retrospective analysis of 68 lower extremity bypass procedures.
  • Inclusion criteria: 53 patients aged 75 years and older with severe lower limb ischemia.
  • Follow-up included assessment of operative mortality, limb salvage, patient survival, graft patency, and survival with an intact limb.

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Main Results:

  • Operative mortality was 4.4%.
  • Two-year cumulative outcomes: 77% limb salvage, 72% patient survival, 44% graft patency, and 56% survival with an intact limb.
  • Notably, 66% of deceased patients had an intact limb at the time of death, suggesting limb viability is often maintained.

Conclusions:

  • Lower extremity bypass surgery can achieve favorable limb salvage rates in elderly patients (≥75 years) with severe ischemia.
  • The data support the continued offering of reconstructive surgery to carefully selected elderly patients.
  • Maintaining limb viability is a significant outcome, even in patients who do not survive the procedure.