Arterial Diseases of the Aged

With Special Reference to the Reconstructive Vascular Surgery for A. S. O. of the Lower Extremity and Renal Artery, and the Abdominal Aortic Aneurysm

Abstract

During a period of 14 years (1970-1983), the reconstructive vascular surgery was applied to 143 cases (202 limbs) with athero-occlusive diseases (A. S. O.) and 18 cases with renal artery atherosclerosis showing renovascular hypertension and/or renal dysfunction. The operation was indicated for intermittent claudication (117 cases) and the severely ischemic legs due to the diffuse atherosclerosis or the acute arterial thrombosis (26 cases). Large number of the patients under 69 years of age came into the group with intermittent claudication (91% of the cases). But for the more aged patients, limb salvage was the chief purpose of the operation (15 among 23 cases). Early and late operative results for intermittent claudication were quite satisfactory. The five-year patency rate of the bypass graft implanted for aortoiliac A. S. O. was 80%. But limb salvage rate for the severely ischemic legs was only 57%. All of the cases who underwent remedial operation to the renal arteries showed severe hypertension (average, 201/114mmHg). Seven cases were impaired their renal function. Cure or improvement of hypertension was obtained in 83% of patients. Although 5 of 7 patients were normalized their renal function, acute renal failure occureed to 3 patients immediately after the reconstruction with one death. Two hundred and fifty cases underwent abdominal aneurysmectomy during the period of 32 years (1952-1983). Recently the operative results have been markedly improved. The operative mortality is 4.5% for the elective cases and is 17% for the ruptured during the recent 10 years. There was a significant difference between the 5-year survival rate of the operated and that of the non-operated (62% for the operated, 16% for the non-operated). The predominant cause of death of the non-operated was a rupture of the aneurysm (38%). On the basis of these results, the conclusion is summarized as following. 1) Reconstructive vascular surgery benefits the aged patient with intermittent claudication to enjoy the rest of his life actively. 2) Acute arterial thrombosis is not only limb theratening but sometimes a fatal condition for the aged patients and difficult to treat even in the recent years. 3) Renal artery reconstruction is the treatment of choice for renovascular hypertension due to atherosclerosis, but one of the problems to be solved is occasional occurence of acute renal failure immediately after the operation in the cases with renal malfunction caused by severe bilateral disease. 4) Life prolongation effect of the abdominal aortic aneurysmectomy is clearly confirmed, therefore an active attitude is advisable to operate for the abdominal aortic aneurysm.