Vascular surgical society of great britain and ireland: limb salvage in the octogenarian

BACKGROUND: Critical limb ischaemia (CLI) presents a unique set of problems in the elderly patient. Foremost among these is the much greater likelihood of loss of independence and reduced quality of life if major amputation is required. For this reason it has been this unit's policy to attempt reconstructive vascular surgery in almost all cases of CLI. The outcome of this policy was examined. METHODS: All patients had surgery performed under one consultant and data were entered prospectively on to a database. RESULTS: Risk factors included diabetes (17 per cent), smoking (78 per cent) and ischaemic heart disease (31 per cent). Some 127 patients had either femoropopliteal (59), femorodistal (64) or popliteal-distal grafts (four) performed for limb-threatening ischaemia. Follow-up was performed at 3, 6 and 12 months and then at annual intervals until death. Seventeen of these patients required a subsequent major amputation, 12 at the below-knee and five at the above-knee level. Mean follow-up was 2 years. The perioperative mortality rate was 15 per cent, although eight of these patients were admitted with acute or chronic ischaemia. Cumulative graft secondary patency rate was 68 per cent at 4 years for vein grafts. Some 95 per cent of patients with patent grafts were independently mobile. CONCLUSION: Excellent results can be achieved for limb salvage with a relatively low morbidity in this group. Elderly patients with CLI do not live long and avoidance of amputation is particularly desirable in order to maximize the quality of their remaining life.