Arterial embolectomy. A long-term perspective.

One hundred and thirteen elderly patients (median age 77 years, range 37-99) were followed up for 2-10.5 years after embolectomy in order to assess the late outcome. There were two groups of patients: those who had suffered an embolism (84) and those who in retrospect had thrombosis in situ (29). Thirty three of the embolus group (39%) died within 30 days of surgery, and factors associated with mortality (p less than 0.05) were age greater than 80 years, and failure to save the limb (17%). In the thrombosis group limb loss was more common (76%) and these patients also had a higher mortality (55%). Mean long term survival in the embolus group was 35 months (range 1-108 months) with a high mortality rate in the first 6 months after embolectomy and improved survival after this. There were no significant differences in mortality or cardiovascular events between the 27 patients on long term warfarin and the 19 patients not anticoagulated. Mortality after embolectomy is high but there remains a group of long term survivors. The value of oral anticoagulation for these patients remains unresolved.