Limb salvage in elderly patients. Is aggressive surgical therapy warranted?
Arteriovenous Shunt, Surgical
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.