Document Detail

Management of acute leg ischaemia in the elderly.
MedLine Citation:
PMID:  9501820     Owner:  NLM     Status:  MEDLINE    
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.
B D Braithwaite; B Davies; P A Birch; B P Heather; J J Earnshaw
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The British journal of surgery     Volume:  85     ISSN:  0007-1323     ISO Abbreviation:  Br J Surg     Publication Date:  1998 Feb 
Date Detail:
Created Date:  1998-03-26     Completed Date:  1998-03-26     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0372553     Medline TA:  Br J Surg     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  217-20     Citation Subset:  AIM; IM    
Department of Surgery, Gloucestershire Royal Hospital, UK.
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MeSH Terms
Aged, 80 and over
Anticoagulants / adverse effects,  therapeutic use
Cause of Death
Embolectomy / methods
Ischemia / drug therapy,  surgery,  therapy*
Leg / blood supply*
Thrombolytic Therapy / adverse effects,  methods
Treatment Outcome
Reg. No./Substance:

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