Peripheral vascular disease--the geriatrician's tale

Area of Science:

• Geriatrics
• Vascular Surgery
• Epidemiology

Background:

• Peripheral vascular disease (PVD) is a significant health concern in the elderly population.
• Many elderly patients with PVD are diagnosed late, often during acute systemic illnesses.
• PVD in older adults is frequently under-suspected until advanced stages.

Purpose of the Study:

• To investigate the prevalence, presentation, and prognosis of peripheral vascular disease in elderly patients.
• To highlight the challenges in diagnosing and managing PVD in geriatric populations.
• To emphasize the need for increased vigilance for PVD in the elderly.

Main Methods:

• Retrospective analysis of 124 elderly patients with peripheral vascular disease over nearly 4 years.
• Inclusion of patients presenting with critical ischemia and those diagnosed during acute illnesses.
• Documentation of disease laterality, progression, and treatment outcomes.

Main Results:

• Half of the patients presented with previously unknown critical ischemia.
• Two-thirds had bilateral disease; 14.5% developed PVD manifestations during acute illnesses.
• Mortality was high: 33% within 3 months, 18.5% within 2 years.
• Among survivors, 37% experienced persistent pain, ulceration, necrosis, gangrene, or amputation.
• Only 5 patients underwent successful limb salvage procedures.

Conclusions:

• Peripheral vascular disease in the elderly is common, often presents late, and carries a dismal prognosis.
• Under-suspicion and delayed diagnosis contribute to poor outcomes in geriatric PVD.
• Continuous vigilance for PVD, meticulous foot care, and heightened awareness during acute illnesses are essential for elderly patients.