Peripheral vascular disease--the geriatrician's tale

One hundred and twenty four elderly patients with peripheral vascular disease were seen by a geriatrician over a period of just under 4 years. Half of them presented with critical ischaemia and had not been previously known to have peripheral vascular disease. Two-thirds were shown to have bilateral disease; 14.5% of the series developed manifestations of the condition during the course of acute systemic illnesses and in 5 cases this was almost certainly, and in several more probably, due to haemodynamic crises. A third were dead within 3 months and so far a further 18.5% are known to have died within 2 y of first encounter. Of those who survived 3 months, at least 37% required treatment for persistent rest pain or had skin ulceration or necrosis, or had developed gangrene or come to amputation. Only 5 patients, after investigation, underwent successful limb salvage procedures. Peripheral vascular disease in old people is common, is likely to continue to be so, carries a dismal prognosis, and appears on the evidence presented here to be under-suspected until an advanced stage in the disease. Those dealing with the aged must be constantly on the alert for it since it calls for scrupulous care of the feet and for especial vigilance during acute systemic illness.