Related Experiment Videos
Arterial reconstruction in elderly patients
1First Department of Surgery, Yamaguchi University School of Medicine, Ube, Japan.
Insights
Elderly patients aged 70+ undergoing peripheral arterial reconstruction for arteriosclerosis obliterans have similar operative mortality but higher long-term mortality compared to younger patients. However, limb salvage rates remain high, supporting surgical intervention.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Cardiovascular Research
Background:
- Peripheral arterial obstruction due to arteriosclerosis obliterans is a significant health concern, particularly in elderly populations.
- Surgical intervention is a primary treatment modality, but its efficacy and safety in older patients require careful evaluation.
Purpose of the Study:
- To analyze the surgical outcomes of primary peripheral arterial reconstruction in patients stratified by age.
- To compare operative mortality, long-term survival, graft patency, and limb salvage rates between elderly (>=70 years) and younger (<70 years) patient groups.
Main Methods:
- Retrospective analysis of 121 procedures in 95 patients aged >=70 years (Group 1) and 215 procedures in 148 patients aged <70 years (Group 2).
- Comparison of operative mortality, long-term mortality, 5-year survival, 5-year graft patency (suprainguinal and infrainguinal), and 5-year limb salvage rates between the two age groups.
Main Results:
- Operative mortality rates were similar (4% vs. 3.4%).
- Long-term mortality was significantly higher in the elderly group (33% vs. 18.9%, P < 0.05), with cardiac failure being the most common cause of death.
- Cumulative 5-year survival rates were lower in the elderly group (56.3% vs. 78.3%, P < 0.0001).
- Suprainguinal bypass graft patency and limb salvage rates were comparable between groups, while infrainguinal reconstruction showed a trend towards lower patency in the elderly group.
Conclusions:
- Despite higher long-term mortality, elderly patients aged 70 and above experience comparable operative mortality and limb salvage rates following peripheral arterial reconstruction.
- The findings support an aggressive surgical approach for arteriosclerosis obliterans in elderly patients, acknowledging the increased risk of long-term mortality, primarily due to cardiac causes.
Abstract:
The surgical results of primary peripheral arterial reconstruction for arteriosclerosis obliterans during a 16-year period were examined as a function of age. Data in group 1 were of 121 procedures performed on 95 patients aged > or = 70 years and those in group 2 of 215 procedures performed on 148 patients aged < or = 69 years. There was no significant difference between the operative mortality rate of 4% (four of 95) in group 1 and 3.4% (five of 148) in group 2. The long-term mortality rate was 33% (31 of 95) in group 1, significantly higher (P < 0.05) than 18.9% (28 of 148) in group 2. The most common cause of death in both groups was cardiac failure. Cumulative 5-year survival rates in groups 1 and 2 were 56.3 and 78.3% respectively (P < 0.0001). The cumulative primary 5-year patency rates of suprainguinal bypass grafts in the two groups were 94.2 and 90.4%, respectively, while those of infrainguinal reconstruction were 67.7 and 55.0% respectively. The 5-year cumulative limb salvage rate was 93.1% in group 1 and 92.7% in group 2. None of these differences was significant. The results support an active approach to surgery in elderly patients with peripheral arterial obstruction caused by arteriosclerosis obliterans.