Limb salvage in elderly patients. Is aggressive surgical therapy warranted?
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Elderly patients aged 80+ with limb-threatening ischemia can safely undergo arterial reconstructive surgery. This study shows low mortality and high limb salvage rates, supporting aggressive treatment for this population.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Cardiovascular Disease
Background:
- Increasing life expectancy leads to more elderly patients with limb-threatening atherosclerotic occlusive disease.
- Arterial reconstructive surgery is often considered too high-risk for these older patients.
Purpose of the Study:
- To evaluate the safety and efficacy of arterial reconstructive surgery in patients aged 80 years or greater with limb-threatening ischemia.
- To determine procedural mortality and limb salvage rates in this elderly demographic.
Main Methods:
- Retrospective review of 64 surgical procedures in 50 patients (aged 80-97 years) over a six-year period.
- Analysis of procedural mortality, cumulative survival rates, and limb salvage rates using life table methods.
Main Results:
- Procedural mortality rate was 3.1%.
- 1-year survival rate was 92%, with 2- and 3-year rates at 76%.
- 1-year limb salvage rate was 92%, decreasing to 83% by 3 years; 79% of non-survivors had their limb intact.
Conclusions:
- Arterial reconstruction is a viable and effective treatment option for elderly patients with limb-threatening ischemia.
- Age alone should not be a contraindication for revascularization procedures in this patient group.
Abstract:
With the continued increase in life expectancy in the United States, the number of elderly patients presenting with limb-threatening atherosclerotic occlusive disease will also rise. The risk of arterial reconstructive surgery has been considered prohibitive in many of these individuals. During a six-year period, 50 patients aged 80 years or greater underwent a total of 64 surgical procedures for limb-threatening ischemia: 17 men (34%) and 33 women (66%). Ages ranged from 80 to 97 with a mean of 84 years. The procedural mortality rate was 3.1%. Cumulative life table survival rates for these patients were at 1 year, 92%; at 2 years, 76%; and at 3 years, 76%. The cumulative life table limb salvage rates were 92%, 88%, and 83% at the same intervals. Of the patients who died during the follow-up periods, 79% still had their previously-threatened limb intact. The results in these patients, as well as those from other series, support an aggressive policy of arterial reconstruction for elderly patients with limb-threatening ischemia. Age, per se, is not a contraindication to revascularization.