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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 2002 September;9(3):257-67
language: English, Italian
Femoro-distal bypass for limb salvage in octogenarians: is it justified?
Grego F., Lepidi S., Milite D., Cognolato D., Frigatti P., Morelli I., Deriu G. P.
Vascular Surgery Clinic, Padua University, Padua
Background. Revascularisation for limb salvage in the elderly is still controversial. This group of patients is usually considered to have an increased perioperative risk because of a high prevalence of severe co-morbidity factors. We have maintained an aggressive policy of distal revascularisation for limb salvages in octogenarians.
Methods. We performed a retrospective review of patients undergoing femorodistal bypass for limb salvage from January 1990 to December 1999. We have divided these patients into 2 groups: Group A: patients aged under 80, Group B: patients aged 80 or older. An analysis was made of demographic factors, preoperative indications for surgery, site of distal anastomosis, graft patency, limb salvage and mortality. Distal pulse evaluation and duplex scan were used to assess graft patency. Statistical analysis was performed using the χ2 and Log-rank test for life tables.
Results. Two hundred and forty distal bypasses were perfor-med for limb salvage. Forty-three patients were octogenarians (Group B) (mean age 84 years, range 80-91) and 197 patients were aged under 80 (Group A). There was no statistical difference in risk factors between the two groups. Limb salvage was the only indication for surgery. The sites of distal anastomosis were similar in the two groups. There was no statistical difference in primary patency rate and limb salvage between the two groups. The cumulative life table survival rate was 42% in Group B and 63% in Group A at 60 months. The cumulative life table limb salvage rates was 40% in both groups at 60 months.
Conclusions. The prevalence of peripheral arterial occlusive disease (PAOD) increases in the elderly population. Our study shows that femorodistal bypass in octogenarians is a safe procedure with graft patency, limb salvage and mortality rates comparable to those reported for younger patients.