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Lower limb embolus: a near-lethal disease after age 75 years
P Y Rolland1, K P Baliga, J C Rice
1Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112.
Southern Medical Journal
|February 1, 1989
Summary
Lower-extremity embolectomy in high-risk elderly patients showed a 17% perioperative mortality and 43% six-month mortality. This study reviews outcomes for this vulnerable patient group undergoing embolectomy.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Cardiovascular Research
Background:
- Embolectomy for lower-extremity ischemia is common.
- Concerns exist regarding high morbidity and mortality in elderly, high-risk populations undergoing embolectomy.
Purpose of the Study:
- To review the experience and outcomes of lower-extremity embolectomy in an elderly, high-risk patient cohort.
- To assess perioperative and long-term mortality rates associated with this procedure in this specific demographic.
Main Methods:
- Retrospective review of 153 consecutive patient records, with 69 selected for analysis.
- Data collected included patient demographics, comorbidities (smoking, diabetes, cardiac disease, hypertension), admission status (myocardial infarction, arrhythmias), and New York Heart Association (NYHA) classification.
- Perioperative and six-month mortality were primary outcome measures.
Main Results:
- The study analyzed 69 patients (45 men, 24 women) with a mean age of 79.5 years.
- Perioperative mortality was 17% (12/69), and six-month mortality was 43% (30/69), with 27 deaths attributed to cardiovascular causes.
- Comorbidities like smoking (42/69) and hypertension (48/69) were prevalent. Simultaneous embolus and myocardial infarction resulted in 100% mortality for survivors. Amputation was required in 15 patients.
Conclusions:
- Lower-extremity embolectomy in elderly, high-risk patients is associated with significant perioperative and long-term mortality.
- The findings underscore the critical nature of this procedure and the need for careful patient selection and management in this population.
- Co-existing conditions, particularly myocardial infarction, portend a very poor prognosis.