Surgery for Acute Lower Limb Ischemia in the Elderly Population: Results of a Comparative Study
ABSTRACT To evaluate the outcome of surgical treatment of acute lower limb ischemia in elderly patients. The primary endpoints were early and midterm rates of survival and limb salvage.
A retrospective analysis involving 76 consecutive patients observed for acute lower limb ischemia between March 2005 and December 2008 who underwent revascularization was conducted. A total of 44 patients (group A) of age >80 years (average age: 86.9 ± 4.5 years; 13 men and 31 women) had a site of obstruction at the level of abdominal aorta in one case (2.3%), common-external iliac artery/common femoral artery in 15 (34.1%), superficial femoral artery/popliteal artery in 26 (59.1%), and infrapopliteal arteries in two (4.5%), and embolectomy, thrombectomy, bypass, and angioplasty was performed in 24 (54.5%), 11 (25.0%), eight (18.2%), and one (2.3%) case(s), respectively. A total of 32 patients (group B) of age <80 years (average age: 67.2 ± 12.2 years; 19 men and 13 women) with an analogous site of obstruction at the level of abdominal aorta in one case (3.1%), common/external iliac artery/common femoral artery in 12 (37.5%), superficial femoral artery/popliteal artery in three (9.4%), and infrapopliteal arteries in 16 (50.0%) underwent the same aforementioned procedures in 10 (31.3%), 12 (37.5%), nine (28.1%), and one (3.1%) case(s), respectively.
At 30 days after surgery, survival and limb salvage were both 93.2% in group A versus 96.9% and 87.5%, respectively, in group B, whereas they were 93.2% and 65.8%, respectively, in group A versus 85.7% and 96.9%, respectively, in group B (p = 0.22 and p = 0.19, respectively) at the midterm control. The univariate and multivariate analyses showed that category 2b of acute ischemia (immediately-threatening) has a negative statistically significant influence on the survival rate (p = 0.01).
Limb salvage rates after surgical intervention for acute lower limb ischemia in the elderly population are comparable with those of the younger population, whereas survival rates are lower, but without statistical significance. The only factor that negatively influences the survival rate is the 2b clinical category of acute ischemia, regardless of the age of the patient.
- SourceAvailable from: Francesco Setacci
Article: Acute limb ischemia in nonagenarians[Show abstract] [Hide abstract]
ABSTRACT: Aim: Acute limb ischemia (ALI) is not infrequently associated with limb loss (10-30%) or death of the affected patient (15-30%). These results can be even worse in elderly population. The aim of this study is to quantify safety and efficacy of early revascularization in over 90 years old patients with acute limb ischemia. Methods: This is a prospective registry lasting from January 2012 to January 2013. We include all consecutive over 90 years patients treated for ALI (N.=15). A careful preoperative Duplex scan (DS) were performed in each patient. All patients underwent surgery by Fogarty's embolectomy, and endovascular completion procedure if needed (N.=3). Results: We performed 18 revascularizations (15 lower limbs, 3 upper limbs) in 15 patients (2 staged bilateral femoral, 1 simultaneous bilateral femoral). The mean follow-up was 124 days (4-365). Technical success was obtained in 16 cases (88.9%). At disharge mortality was 5.9% (1 case), and amputation rate was 6.2% (1 pt). The Kaplan-Meier curves at 1 year revealed an estimated freedom from death, amputation and re-occlusion of 76.5%, 88.2%, and 71.3%, respectively. Conclusion: The over 90 years old patient represent a challenging case for vascular surgeon. Vascular procedures involve high mortality rate but emergent revascularization by Fogarty Embolectomy in ALI is safe and effective even in older patient.The Journal of cardiovascular surgery 10/2013; 54(5):625-31. · 1.37 Impact Factor
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ABSTRACT: To retrospectively evaluate the safety and efficacy of the Spider filter embolic protection device (EPD) in protecting patients from distal migration of thromboemboli during revascularization of acute superficial femoral artery (SFA) occlusion secondary to thromboemboli. Data from all patients at our institution who had EPD placement for embolic protection during endovascular revascularization for acute thromboembolic occlusion of the SFA were analyzed. From April 2007 to June 2014, a total of 14 patients had EPD placement during endovascular revascularization for acute SFA occlusion secondary to thromboemboli. All patients presented with acute onset of limb ischemia, and further work-up with imaging studies demonstrated thromboembolic occlusions. The duration from onset of symptoms to revascularization was 7.0 ± 2.7 h (range 2-14 h). An aspiration technique for thrombectomy was used in all 14 cases (aspiration alone, 6 cases; aspiration plus urokinase, 7 cases; additional angioplasty after urokinase, 1 case). Spider filter EPDs were successfully placed at the target in all 14 cases, and the thromboemboli were captured in 13/14 (92.9 %) cases. Successful reestablishment of the SFA flow without distal branch embolism occurred in all 14 cases. There were no EPD-related complications. During a mean 32.2 ± 20.2 months of follow-up, 13 patients remained asymptomatic; one patient who underwent PTA during the procedure reported limb coolness and fatigue 6 months later because of recurrent atherosclerotic stenosis. The Spider filter EPD can be safe and effective in protecting patients from distal branch embolism when they undergo an endovascular thrombectomy procedure.CardioVascular and Interventional Radiology 03/2015; DOI:10.1007/s00270-015-1086-3 · 1.97 Impact Factor