Revascularization in older patients with chronic limb ischemia

Dr Sonia Anand is a professor in the Division of Cardiology, associate chair of Equity and Diversity in the Department of Medicine, and director of the Population Genomics Program at McMaster University.

Should revascularization procedures in chronic limb ischemia be limited in older patients depending on their age or performance status?

Sonia Anand, MD, PhD: Not necessarily. If we worked in a health-care system where there were unlimited resources and the patient had a lower risk of cardiovascular complications, it would be reasonable to revascularize older patients as well, but we do have limited resources. The majority of patients seem to be well managed with medical therapy and it is only if they develop critical limb ischemia where they require referral to a surgeon.

If you are trying to prevent something as serious as an amputation of the leg, I think irrespective of the age of the patient that referral should be made to give them a chance. Once a patient has a major amputation, it has a significant impact on their quality of life and the recurrent hospitalization [rate] is very high.

I would add for all patients with peripheral artery disease (PAD), for the physicians working with their patients to bring smokers to become nonsmokers is crucial. We could talk a lot about expensive medications or peripheral vascular surgery but a cornerstone of management is to make the smoking patient a nonsmoker.