Lower limb embolus: a near-lethal disease after age 75 years.

Because it has been suggested that embolectomy increases morbidity and mortality, we reviewed our experience with lower-extremity embolectomy in an elderly high-risk population. Of 153 consecutive patient records reviewed, 69 were sufficiently complete for analysis. Of these patients, 45 were men with a mean age of 80.7 years (range, 75 to 91 years); 24 were women with a mean age of 76.9 years (range, 75 to 81 years). Records were reviewed for patient age, sex, race, acute myocardial infarction or atrial fibrillation upon admission, history of smoking, diabetes, and cardiac disease (acute and chronic), admission blood pressure, role of postoperative echocardiography, and New York Heart Association classification (NYHA class). All patients were hemodynamically stable at the time of operation. Forty-two of the 69 patients had a history of smoking, nine were diabetic, and 48 (33 men and 15 women) had hypertension (blood pressure greater than 140/90 mm Hg) on admission. Twelve deaths occurred within the perioperative period. Nine patients had an acute myocardial infarction and 12 had arrhythmias on admission. Thirty patients (15 men and 15 women) were in NYHA class III. A total of 30 patients had died by six months postoperatively, 27 of cardiovascular causes. The perioperative mortality was 12/69 (17%), and long-term mortality was 30/69 (43%). Simultaneous embolus and myocardial infarction was associated with 100% mortality for the patients surviving the operation; 15 patients required another operation for amputation (nine above-knee and six below-knee).