Infrapopliteal arterial reconstructions for limb salvage in patients aged > 80 years according to preoperative ambulatory function and residential status.

IF. 3.406 Abstract Objective: Although numerous studies have addressed peripheral revascularizations for critical limb ischemia (CLI) in patients aged 80 years or more, only a few have focused exclusively on infrapopliteal arterial reconstructions. This study aimed to analyze early and long-term outcomes in very elderly patients who underwent surgical infrapopliteal revascularization for CLI according to their preoperative ambulatory function and residential status. Patients and Methods: Over an 18-year period, all consecutive patients aged 80 years or more referred to our institution for CLI requiring primary infrapopliteal or inframalleolar arterial reconstruction were enrolled in the study. All procedures were completed by the same surgeon with patients under regional anesthesia. Patency, limb salvage, amputation-free survival and cumulative survival rates were assessed by Kaplan-Meier analysis. The patient’s pre- and postoperative ambulatory function and residential status (at home vs in a nursing home) were also analyzed. The mean follow-up was 6.2 years (range, 0.1-11.5 years) and was obtained for 97.5% of the patients. Results: In all, 197 patients (134 men, mean age, 82.8 ± 1.7 years) with 201 critically ischemic limbs were enrolled in the study. No deaths or fatal major complications occurred in the perioperative period (30-day), while the local complication rate was 5.6%. After 1 and 7 years, the primary patency rates were 87.9% and 67.8%, the limb salvage rates were 96% and 86.7%, the amputation-free survival rates were 87.6% and 38.9%, and the survival rates were 91% and 44.2%. At last follow-up or death, 79.7% of the patients were ambulatory and 20.3% were not, 80.2% lived at home and were independent and another 9.1% lived at home with assistance, while 75.6% of the sample were living at home and were ambulatory. Conclusions: Infrapopliteal arterial revascularization in the very elderly with CLI proved safe, effective and durable, confirming that age per se and concomitant comorbidities do not necessarily affect technical and clinical outcomes. Ambulatory function and independent living status are well preserved since, despite a relatively short life expectancy, the majority of very elderly revascularized CLI patients can be expected to spend their remaining years ambulatory and at home. On the other hand, patients with poor ambulatory function or who needed assistance before surgery were less likely to improve their status after limb revascularization, despite a successful technical result.