AMPUTATION OR REVASCULARIZATION IN THE LESS-THAN-OR-EQUAL-TO-70 YEAR-OLD

An aggressive posture toward limb salvage in the elderly was assessed by retrospective review of a 5 year experience. A total of 302 primary lower extremity revascularizations and 465 primary major amputations were performed; of these, 62 per cent (472/767) were performed in pati ents 70 years or older (range 70-104, mean 78). Psychosocial status wa s utilized to indicate primary amputation; revascularization was attem pted in all patients capable of ambulation or transfer. Revascularizat ion was performed in 119 patients > 70 years old (44 femoropopliteal, femorotibial, or sequential, 24 extra-anatomic, and 11 miscellaneous) with a 30-day mortality of 8 per cent, thrombosis 12 per cent, and ear ly amputation 7 per cent. There were five additional mortalities and t hree amputations, for a 77 per cent life and limb salvage at one year. This contrasted with a 2.2 per cent mortality (P < 0.05), 5.4 per cen t thrombosis, and 3.3 per cent amputation rate in 183 revascularizatio ns in < 70 year old patients. Primary amputation was performed with an 8 per cent (23/253) mortality in 253 patients > 70 years old undergoi ng 192 above and 61 below-knee procedures. There were two mortalities in 154 elective cases, but a 22 per cent rate in urgent situations (P < 0.01) ranging from 66 per cent (12/18) for emergency and 25 per cent (3/12) guillotine to 8 per cent (6/69) for physiologic amputation (P < 0.001). Fifty per cent of all amputation survivors died within 1 yea r. The comparative mortality for 212 amputations in < 70 year old pati ents was 1.5 per cent (P < 0.01). Aggressive revascularization at this age carries a significantly higher mortality, but 77 per cent will ob tain ambulatory limb salvage at 1 year. Primary amputation should be d one early to avoid an excessive mortality and when done urgently shoul d be done as a physiologic amputation, to avoid the increased mortalit y associated with emergency surgery.