LOWER-LIMB ISCHEMIA IN THE OCTOGENARIAN - IS LIMB SALVAGE SURGERY WORTHWHILE

Vascular surgeons are being asked to manage vascular disease in an inc reasingly elderly population, and advanced age may be considered a rel ative contraindication to limb salvage surgery with an amputation seem ing the preferred option. We present a review of 50 patients over the age of 80 years, presenting with ischaemic rest pain, ulceration or ga ngrene of the lower extremity. Six patients were treated conservativel y, four of whom died during the same admission. Only two patients prov ed suitable for transluminal angioplasty as the sole curative procedur e. Twelve patients (24%) underwent primary amputation with a periopera tive mortality of 3/12 (25%). Five patients (10%) had an iliac bypass procedure, and 25 patients (50%) were considered suitable for infraing uinal bypass. Of the latter group 14 had femoropopliteal bypasses, and 11 had femorodistal bypasses with an overall perioperative mortality of 3/25 (12%). Mortality at 6 months was high (33%) and was similar in both the grafted and amputation groups. Patients having reconstructio n fared well in terms of independent mobility, use of long-term care, and length of hospital stay. Patients over 80 years of age with critic al ischaemia should not be denied the opportunity of vascular reconstr uction.