Limb salvage in elderly patients. Is aggressive surgical therapy warranted?

Overview

With the continued increase in life expectancy in the United States, the number of elderly patients presenting with limb-threatening atherosclerotic occlusive disease will also rise. The risk of arterial reconstructive surgery has been considered prohibitive in many of these individuals. During a six-year period, 50 patients aged 80 years or greater underwent a total of 64 surgical procedures for limb-threatening ischemia: 17 men (34%) and 33 women (66%). Ages ranged from 80 to 97 with a mean of 84 years. The procedural mortality rate was 3.1%. Cumulative life table survival rates for these patients were at 1 year, 92%; at 2 years, 76%; and at 3 years, 76%. The cumulative life table limb salvage rates were 92%, 88%, and 83% at the same intervals. Of the patients who died during the follow-up periods, 79% still had their previously-threatened limb intact. The results in these patients, as well as those from other series, support an aggressive policy of arterial reconstruction for elderly patients with limb-threatening ischemia. Age, per se, is not a contraindication to revascularization.