TY - JOUR
T1 - Management of acute leg ischaemia in the elderly
AU - Braithwaite, B. D.
AU - Davies, B.
AU - Birch, P. A.
AU - Heather, B. P.
AU - Earnshaw, J. J.
PY - 1998
Y1 - 1998
N2 - Background: Peripheral thrombolysis is advocated by some as the best initial treatment for acute leg ischaemia, but this may not be true for elderly patients. This study reviewed the management of acute leg ischaemia in patients aged over 75 years. Methods: Over a 5-year interval, 91 events of acute leg ischaemia in 84 patients were managed in a single district general hospital according to a local protocol. There were 60 women and 24 men of median age 81 (range 75-100) years. Fifteen patients were too elderly and infirm for active treatment and received anticoagulation alone. Some 76 events (84 per cent) occurred in patients suitable for active therapy: 33 were managed by initial surgery and 43 by peripheral thrombolysis with tissue plasminogen activator. Results: Overall outcome after 30 days was limb salvage in 48 (53 per cent), amputation in five (5 per cent) and death in 38 (42 per cent). In actively treated patients the corresponding values were 43 (57 per cent), four (5 per cent) and 29 (38 per cent). Initial successful revascularization was more likely following surgery (29 of 33 versus 25 of 43 events with thrombolysis, P < 0.01), but the 30-day outcome was similar in the actively treated groups owing to subsequent morbidity and mortality. Conclusion: A group of patients (mostly women) with emboli could be identified, using clinical criteria, who had a high chance of successful revascularization following embolectomy. Late outcome remained poor due to associated co-morbid conditions. Thrombolysis is associated with substantial risk in the elderly, and with high complication rates.
AB - Background: Peripheral thrombolysis is advocated by some as the best initial treatment for acute leg ischaemia, but this may not be true for elderly patients. This study reviewed the management of acute leg ischaemia in patients aged over 75 years. Methods: Over a 5-year interval, 91 events of acute leg ischaemia in 84 patients were managed in a single district general hospital according to a local protocol. There were 60 women and 24 men of median age 81 (range 75-100) years. Fifteen patients were too elderly and infirm for active treatment and received anticoagulation alone. Some 76 events (84 per cent) occurred in patients suitable for active therapy: 33 were managed by initial surgery and 43 by peripheral thrombolysis with tissue plasminogen activator. Results: Overall outcome after 30 days was limb salvage in 48 (53 per cent), amputation in five (5 per cent) and death in 38 (42 per cent). In actively treated patients the corresponding values were 43 (57 per cent), four (5 per cent) and 29 (38 per cent). Initial successful revascularization was more likely following surgery (29 of 33 versus 25 of 43 events with thrombolysis, P < 0.01), but the 30-day outcome was similar in the actively treated groups owing to subsequent morbidity and mortality. Conclusion: A group of patients (mostly women) with emboli could be identified, using clinical criteria, who had a high chance of successful revascularization following embolectomy. Late outcome remained poor due to associated co-morbid conditions. Thrombolysis is associated with substantial risk in the elderly, and with high complication rates.
UR - http://www.scopus.com/inward/record.url?scp=0031909967&partnerID=8YFLogxK
U2 - 10.1046/j.1365-2168.1998.00577.x
DO - 10.1046/j.1365-2168.1998.00577.x
M3 - Article
C2 - 9501820
AN - SCOPUS:0031909967
SN - 0007-1323
VL - 85
SP - 217
EP - 220
JO - British Journal of Surgery
JF - British Journal of Surgery
IS - 2
ER -