SURGERY FOR CHRONIC LOWER-EXTREMITY ISCHEMIA IN PATIENTS 80 OR MORE YEARS OF AGE - OPERATIVE RESULTS AND ASSESSMENT OF POSTOPERATIVE INDEPENDENCE

Purpose: Revascularization for chronic lower extremity ischemia (CLEI) in patients 80 or more years of age is controversial. High operative mortality, short remaining life span, and nonambulatory nursing home e xistence are cited as frequent outcomes in this patient group. Despite these considerations we have maintained an aggressive policy of lower extremity revascularization in functional and potentially functional patients 80 or more years of age with limb-threatening ischemia or cla udication sufficient to threaten their independence. Methods: The reco rds of all patients 80 or more years of age who underwent lower extrem ity revascularization for CLEI from 1981 through 1991 were reviewed. P atients were evaluated for surgical indication, perioperative mortalit y, late survival, graft patency, and limb salvage. In addition, the pa tient's preoperative and postoperative independence determined by livi ng situation (home versus nursing home) and ambulatory status were exa mined. Results: During the period reviewed 88 patients 80 or more year s of age underwent 95 arterial reconstructions for CLEI; 95% for limb salvage and 5% for short-distance claudication. There were 81 (85%) in frainguinal bypasses and 14 (15%) extraanatomic bypasses, 5 of which a lso included a simultaneously placed infrainguinal bypass. The periope rative mortality rate was 6%. Mean hospitalization was 18 days (range 6 to 62). The 1- and 3-year primary graft patency rates were 88% and 6 6%, limb salvage rates 94% and 91%, and patient survival rates 73% and 51%, respectively. One year after operation 88% of patients were ambu latory, 85% were living at home, and 80% were both living at home and ambulatory. At 3 years these results were 86%, 76% , and 71%, respecti vely. Of the patients living at home and ambulatory before operation, 100% and 84% of survivors were still living at home and ambulatory 1 a nd 3 years after operation. Of patients living at home who had late gr aft occlusions, 67% required amputation and subsequent nursing home pl acement. Conclusion: Although survival in this group is predictably lo wer than that of age-matched control subjects, octogenarians have sati sfactory 1- and 3-year graft patency, limb salvage, and functional res ults. Revascularization for CLEI in patients 80 or more years of age i s appropriate and results in maintenance of independent living in a la rge majority.