Results of the Surgical Management of Acute Limb Ischemia in the Nonagenarians

Background: The aging of the population leads us to treat older patients, in particular presenting with acute limb ischemia (ALI). However, there has been little evaluation of this pathology in the nonagenarians. The objectives of this work are thus to evaluate the 1-month and 1-year mortality of the nonagenarians treated for ALI, which made possible to determine the 1-year survival and to highlight the factors influencing the mortality. Methods: This is a monocentric retrospective study including all the patients aged 90 years old or more surgically treated for ALI between January 2012 and December 2016. In all the patients, we recorded the 1-month mortality and the 1-year survival and the demographic, clinical, and paraclinical data. Results: We operated 83 nonagenarians, with a majority of women (59, 71.1%), using general anesthesia in 20 patients (16.6%), including 10 cases of upper limb acute ischemia (12.0%). The overall mortality rate at 1 month was 22.9%, and the 1-year survival rate was 43.4%. Major amputation rate was 9.6% at 1 year. The survival of the patients operated for upper or lower limb ischemia was similar (P = 0.82). Univariate analysis showed that the 1-year survival was lower in patients having a history of cerebrovascular problems (P = 0.0003), heart failure (P = 0.0027), dementia (P = 0.0452), or in patients that were institutionalized (P = 0.0125), invalid (P = 0.0001), or presented with a complete acute ischemia (P = 0.0002). In multivariate analysis, 3 risk factors remained statistically significant: a previous history of cerebrovascular accident (hazard ratio [HR] = 3.05 [1.54-6.02]; P = 0.0014), cardiac failure (HR = 2.21 [1.23-3.97]; P = 0.0083), and complete ALI (HR = 3.07 [1.64-5.75]; P = 0.0005). Conclusions: Our study showed that a history of cerebrovascular accident, cardiac failure, or complete ALI is a poor prognostic factor for the 1-year survival of nonagenarians dealt operated for ALI. These elements should be taken into account when deciding either to operate or not in this precise context.