Tibial and peroneal bypasses in octogenarians and nonoctogenarians with critical limb ischemia

Abstract

Elderly patients with critical limb ischemia are increasingly treated through interventional therapy. The outcome of tibial and peroneal bypasses in octogenarians who were unsuitable for endovascular therapy remains unclear. We conducted a retrospective analysis of all patients who underwent tibial or peroneal bypass surgery in our clinic between October 2007 and April 2015. In Group 1 we included all patients 80years and older and in group 2 all patients under 80years. Vein was used whenever possible (diameter not less than 3mm, not more than two segments for sufficient length). Study end points were primary and secondary patency, limb salvage and survival after 3years. Indications were rest pain in 32.2% and ulcer and gangrene in 67.8%. There were 92 cases in Group 1 (median age, 85years) and 178 in group 2 (median age, 70years). Risk factors and indications were similar in both groups except for gender, renal insufficiency and smoking. 30-day mortality was 9.7% in group 1 and 1.1% in group 2 (P= .001). There was no significant difference in 30-day graft failure and major amputation. At 3years primary patency in group 1 was 58.9% vs 49.7% (P= .058), secondary patency was 73.0% vs 54.7% (P= .007). Limb salvage was 80.1% in group 1 vs 73.0% in group 2 (P= .446), survival was 44.0% vs 71.2% (P= .000). Our analysis showed good results in octogenarians undergoing tibial and peroneal bypass surgery with regardto patency rates and limb salvage. However, octogenarians had a significantly higher perioperative mortality rate.