Surgical Treatment of Occlusive Vascular Disease in the Elderly

Abstract

Severe arterial occlusive disease can manifest as incapacitating claudication or limb-threatening ischemia of the lower extremities. Male cigarette smokers under the age of 65 have been considered in the past as the group with the highest prevalence of aortoiliac occlusive disease. Over the past 20 years it has been noted that there are increasing numbers of women affected with occlusive disease of the aortoiliac segment.1 In addition, with the “graying” of the population and the increased life expectancy of individuals, the number of elderly patients presenting with significant aortoiliac occlusive disease is continuously increasing and becoming a significant and increasing percentage of the patients who require intervention for this disease.2 During the 1990s, the average age of patients requiring aortoiliac reconstructions at our institution increased from 63 years to 68 years. The options for treatment of aortoiliac occlusive disease have evolved since the 1950s, when the initial aortoiliac reconstructions were performed using an arterial prosthesis. Multiple options for arterial reconstructions have been developed to accommodate varied patient arterial anatomy and risks of intervention. Advances in catheter-based techniques, vascular imaging, and other noninvasive tests have paralleled the development of new surgical techniques and procedures. Further advances in the treatment of aortoiliac occlusive disease are based on the combination of percutaneous techniques and surgical skills used to develop and perform endolu-minal bypass.