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Amputation or revascularization in the > 70 year old

T J Bunt1, J M Malone

  • 1Department of Surgery, Maricopa Medical Center, Phoenix, AZ 85010.

The American Surgeon
|May 1, 1994
PubMed
Summary
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Aggressively pursuing limb salvage in elderly patients improved outcomes, with a 77% one-year survival rate for revascularization versus higher mortality for primary amputation. This approach offers better limb salvage for seniors.

Area of Science:

  • Vascular Surgery
  • Geriatric Medicine
  • Surgical Outcomes Research

Background:

  • Elderly patients (≥70 years) represent a significant proportion of lower extremity revascularization and amputation procedures.
  • Limb salvage decisions in this demographic require careful consideration of risks and benefits.
  • Previous data on aggressive limb salvage in the very old are limited.

Purpose of the Study:

  • To assess the outcomes of an aggressive limb salvage strategy in elderly patients.
  • To compare revascularization versus primary amputation in patients aged 70 years and older.
  • To evaluate short-term and one-year mortality and limb salvage rates.

Main Methods:

  • Retrospective review of a 5-year surgical experience.
  • Analysis of 767 primary lower extremity procedures (302 revascularizations, 465 amputations).

Related Experiment Videos

  • Stratification by age (≥70 vs. <70 years) and procedure type (revascularization vs. amputation).

    • Main Results:

    • In patients ≥70 years, revascularization (n=119) had 8% 30-day mortality and 7% early amputation, with 77% one-year life and limb salvage.
    • Younger patients (<70 years) undergoing revascularization (n=183) had significantly lower mortality (2.2%) and amputation rates.
    • Primary amputation in patients ≥70 years (n=253) had 8% mortality, with higher rates in urgent/emergency settings (up to 66%). 50% of amputation survivors died within one year.

    Conclusions:

    • An aggressive limb salvage approach via revascularization in elderly patients (≥70 years) is associated with favorable one-year outcomes.
    • Revascularization in the elderly demonstrates superior life and limb salvage compared to primary amputation, despite higher short-term risks.
    • Careful patient selection and consideration of psychosocial factors are crucial for optimizing surgical strategy in geriatric lower extremity revascularization.