Surgical Aspects of Peripheral Vascular Disease*

Abstract

This article reviews current surgical concepts regarding the management of elderly patients with peripheral vascular disease. The indications for surgical reconstruction may be either relative or absolute, but only absolute indications (e.g., incipient gangrene) apply in the elderly. A review of the natural history of the disease shows that although some cases remain stable for long periods, many progress to a state of serious deterioration with painful intermittent claudication, incipient gangrene and threatened loss of the limb. The mechanisms of deterioration include thrombosis, embolism and minor trauma. Peripheral vascular occlusive disease is only one manifestation of a generalized disease process, and vascular reconstruction is only a palliative measure. However, since high morbidity and mortality are associated with amputation, reconstruction should always be considered, even in the geriatric patient. The aorto‐iliac reconstruction technique is associated with a fairly low mortality rate and a limb‐salvage rate of 85 per cent; simpler alternatives are available in high‐risk patients. For femoro‐popliteal procedures the mortality rate is low and the limb‐salvage rate is 75 per cent. Such results emphasize that vascular reconstruction usually is preferable to amputation. Measures for conservative management, particularly in aged patients, are discussed.