Introduction - Acute limb ischaemia (ALI) is not infrequent in nonagenarians and surgical thromboembolectomy remains the treatment of choice. However, the management of postoperative ipocoagulative therapy is often troublesome, due to the risk of hemorragic complications versus thromboembolic recurrencies. This study aims to review the postoperative and long term outcome of patients > 90 year-old patients submitted to limb thromboembolectomy with particular attention to the impact of oral anticoagulant therapy (OAT). Methods - A retrospective 10-year analysis (2006-2016) of all consecutive surgical embolectomies for ALI in > 90 year-old patients was carried out. Perioperative (30-day) and long term outcomes were evaluated in terms of death, limb loss, new embolic events (NEE) and major complications, comparing patients with and without OAT. Pre and postoperative International Normalized Ratio (INR) and activated thromboplastin time (aPTT) laboratory values were also collected and reviewed. Results - Over a total of 295 embolectomies for ALI, 62 (21%) were performed (49 lower limbs, 13 upper limbs) in 41 nonagenarian patients, 32 (51.6%) with permanent and 11 (17.7%) with recent atrial fibrillation (FA). Sixteen (25.8%) were under OAT and 31 (50%) under antiplatelet therapy alone. Vascular dementia was significantly associated with postoperative death and major complication rate (42.1% vs 16.6%, p=.05 and 57.9% vs 31%, p=.05, respectively); diabetes was significantly associated with death and limb loss (66.6% vs 20%, p=.03 and 66.6% vs 7.2%, p=.00, respectively); similarly to preoperative antiplatelet therapy (36% vs 12.9% p=.04, 23% vs 3.2%, p=.03, respectively). At a mean follow up of 28+30 months, the overall survival was 52%, freedom from amputation was 87% and freedom from NEE was 69% with no statistically significant correlation with postoperative OAT. Perioperative death was associated with the presence of higher values of INR and aPTT (2.4±1.4 vs 1.2±0.2, p=.01; 2±0.9 vs 1.5±0.5, p=.04, respectively) and similarly, patients who suffered of postoperative major complications had higher values of INR and aPTT (2±1.3 vs 1.3±0.3, p=.00; 1.9±0.9 vs 1.5±0.4, p=.04, respectively). Conversely, INR and aPTT were significantly lower in patients with limb loss (1.1±0.1 vs 1.7±1, p=.00; 1.3±0.2 vs 1.7±0.7, p=.02, respectively). Conclusion - Long term outcome confirms the effectiveness of surgical thromboembolectomy even in patients with a very advanced age. Since high INR and aPTT values are correlated with higher mortality and complication rates, OAT should be carefully administered in these patients. Its role is however preeminent in preventing future limb ischaemia.