title: Tibial and peroneal bypasses in octogenarians and nonoctogenarians with critical limb ischemia.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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 80 years and older and in group 2 all patients under 80 years. Vein was used whenever possible (diameter not less than 3 mm, not more than two segments for sufficient length). Study end points were primary and secondary patency, limb salvage and survival after 3 years.
  
  
  RESULTS
  Indications were rest pain in 32.2% and ulcer and gangrene in 67.8%. There were 92 cases in Group 1 (median age, 85 years) and 178 in group 2 (median age, 70 years). 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 3 years 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).
  
  
  CONCLUSIONS
  Our analysis showed good results in octogenarians undergoing tibial and peroneal bypass surgery with regard to patency rates and limb salvage. However, octogenarians had a significantly higher perioperative mortality rate.
authors.affiliation: Department of Vascular Surgery, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany. Electronic address: christian.uhl@barmherzige-regensburg.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Uhl
authors.affiliation: Department of Vascular Surgery, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Hock
authors.affiliation: Department of Radiology and Interventional Radiology, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ayx
authors.affiliation: Department of Radiology and Interventional Radiology, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany.
authors.forename: Niels
authors.initials: N
authors.lastname: Zorger
authors.affiliation: Department of Vascular Surgery, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Steinbauer
authors.affiliation: Department of Vascular Surgery, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany.
authors.forename: Ingolf
authors.initials: I
authors.lastname: Töpel
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D016638:Critical Illness; D005858:Germany; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation*