[Vascular surgical emergency in advanced age: arterial embolism--iliofemoral venous thrombosis]

Acute embolic arterial occlusion is the most frequent emergency in vascular surgery; the patients usually have significant heart disease and additional risk factors due to high age. Since 1966 acute embolic occlusions of major vessels of the lower extremity have been operated in 1496 patients; 82% of patients were over 65 years of age--18% even over 80 years. Standardized embolectomy from a small groin incision in local anaesthesia after preoperative check of general conditions has the best prognosis concerned limb salvage. Postoperative long term anticoagulation is performed routinely to prevent recurrent embolization. Preoperative angiography is required only when there is a clinical suspect of preexisting occlusive vessel disease with acute arterial thrombosis. If possible, this group of patients should be subjected to elective reconstructive surgery (fem. pop. bypass, profundoplasty etc.) since embolectomy alone does not mean definitive help in this group. Also for acute iliofemoral venous thrombosis high age is a significant risk factor. Among 240 patients, operated since 1966, about 25% were over 70 years of age. In these patients operative thrombectomy is the only effective means since lysis is usually not performed. Thrombectomy provided a very good result (fully patent veins, normal venous pressure response curves) in 28%. In 64% pressure curves were grossly normal, though recurrent thrombosis had occurred in either femoral or lower leg veins. Only 8% revealed total iliofemoral reocclusion. Thus also in these high risk patients thrombectomy seems to be justified to accomplish early remobilization and prevent respiratory distress syndrome.