title: Institutional results and meta-analysis of outcome after infrainguinal surgical revascularization in patients greater than 80 years old.
abstract: Our aim was to evaluate the outcome after infrainguinal bypass revascularization in patients greater than 80 years old with lower limb ischemia treated at our institution and to perform a meta-analysis of literature data to better estimate current postoperative results. Eighty-four  infrainguinal bypass procedures were performed in 76 patients of at least 80 years of age. Major outcome end points included survival, limb salvage, and amputation-free survival. Systematic review and meta-analysis of literature data on immediate and late outcome in patients older than 80  years who underwent infrainguinal surgical revascularization have been performed. At 30 days, seven patients (8.3%) died and seven major amputations (8.3%) occurred. Kaplan-Meier estimates of survival at 1, 3, and 5 -years were 73.8, 59.8, and 43.1 per cent; leg salvage 78.9, 71.4, and 67.8  per cent; and amputation-free survival 58.3, 42.7, and 28.2 per cent, respectively. The mean survival was 4.6 ± 0.4 years. Only Finnvasc score greater than 2 was predictive of poor late amputation-free survival (at 5 years: 4.5 vs 42.3%; relative risk, 2.19; 95% confidence interval,  1.27 to 3.76). Eleven studies were additionally available for analysis. Pooled estimates of survival at 30 days, 1 year, and 5 years were 94.8, 86.0, and 47.6 per cent, respectively, and of leg salvage were 95.5, 84.7, and 84.1 per cent, respectively. Infrainguinal bypass in patients older  than 80 years carries a significant operative risk and is associated with suboptimal long-term amputation-free survival, which is particularly poor among patients with a Finnvasc score greater than 2.
authors.affiliation: Division of Cardio-thoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland. aristotelis.kechagias@yahoo.gr
authors.forename: Aristotelis
authors.initials: A
authors.lastname: Kechagias
authors.forename: Pekka
authors.initials: P
authors.lastname: Romsi
authors.forename: Kari
authors.initials: K
authors.lastname: Ylönen
authors.forename: Georgios
authors.initials: G
authors.lastname: Kechagias
authors.forename: Tatu
authors.initials: T
authors.lastname: Juvonen
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
mesh_terms: D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D006801:Humans; D007264:Inguinal Canal / Q000601:surgery*; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000379:methods*