LOWER-EXTREMITY ARTERIAL RECONSTRUCTION IN THE VERY ELDERLY - SUCCESSFUL OUTCOME PRESERVES NOT ONLY THE LIMB BUT ALSO RESIDENTIAL STATUS AND AMBULATORY FUNCTION

Purpose: The purpose of this study was to evaluate our results with lo wer extremity arterial reconstruction (LEAR) in patients 80 years of a ge or older and to assess its impact on ambulatory function and reside ntial status. Methods: We performed a retrospective review of all pati ents 80 years of age or older undergoing LEAR at a single institution from January 1990 through December 1995. Preoperative information rega rding residential status and ambulatory function was obtained from the hospital record and vascular registry. Telephone interviews with pati ents or next of kin were undertaken to provide information regarding p ostoperative residential status and ambulatory function. Residential s tatus and level of ambulatory function were graded by a simple scoring system in which 1 indicates living independently, walking without ass istance; 2 indicate living at home with family, walking with an ambula tory assistance device; 3 indicates an extended stay in a rehabilitati on facility, using a wheelchair; and 4 indicates permanent nursing hom e, bedridden. Preoperative and postoperative scores for both residenti al status and ambulatory function were compared. Kaplan-Meier survival curves were generated for graft patency, limb salvage, and patient su rvival. Results: Two hundred ninety-nine lower extremity bypass operat ions were performed in 262 patients 80 years of age or older (45% men, mean age 83.6 years, range 80 to 96 years). Sixty-seven percent of th e patients had diabetes mellitus. Limb salvage was the indication for operation in 96%. The preoperative mean residential status and ambulat ory function scores were 1.79 +/- 0.65 and 1.55 +/- 0.66, respectively . The perioperative mortality rate at 30 days was 2.3%. The median len gth of hospital stay decreased from 16 days in 1990 to s days in 1995 (range 4 to 145 days). Eighty-seven percent of grafts were performed w ith the autologous vein. The 5-year primary, assisted primary, and sec ondary graft patency rates for all grafts were 72%, 80%, and 87%, resp ectively. The limb salvage rate at 5 years was 92%. The patient surviv al rate at 5 years was 44%. The postoperative residential status and a mbulatory function scores were 1.95 +/- 0.80 and 1.70 +/- 0.66, respec tively. Overall scores remained the same or improved in 88% and 78% of patients, respectively. Conclusion: LEAR in octogenarians is safe, wi th graft patency and Limb salvage rates comparable to those reported f or younger patients. LEAR preserves the ability to ambulate and reside at home for most patients.