Surgical results of acute thromboembolic limb ischemia in octogenarians

Patients and methods: Between January 2016 and March 2018, the medical charts of a total of 27 octogenarian patients (16 females, 11 males; median age 85.2±4.3 years; range, 80 to 95 years) who were diagnosed with acute thromboembolic ischemia of the lower or upper limb and underwent urgent thromboembolectomy at our institution were retrospectively analyzed. The 30-day mortality rate of ALI was evaluated. Demographic and clinical characteristics of the patients, associated pathologies, and postoperative outcomes including infection, gastrointestinal bleeding, hematoma, revision surgery, and amputation were recorded.

Results: Nineteen patients (70.3%) had acute lower limb ischemia, while eight patients (29.7%) had acute upper limb ischemia. Acute ischemic pain was the most commonly seen symptom (n=26, 96.3%). Atrial fibrillation was the most common comorbidity in 62.9% patients. Postoperative complications included hematoma (n=5, 18.5%), wound infection (n=4, 14.8%), and gastrointestinal bleeding (n=2, 7.4%). Re-embolectomy was performed in three patients (11.1%). Fasciotomies were performed during follow-up due to compartment syndrome in three patients (11.1%) and these patients subsequently underwent lower limb amputation. The 30-day mortality occurred in two patients due to renal failure and the mortality rate was found to be 7.4%.

Conclusion: Based on our study results, ALI in octogenarians has different outcomes. Our findings suggest that patients with neurological deficit due to delayed ischemia and those with diabetes mellitus and severe ischemia face a higher risk in mortality and morbidity.