Andreas Kastrup, MD, Department of Neurology, Friedrich-Schiller-University of Jena, Jena, Germany.
Klaus Gröschel, MD, Department of Neurology, Friedrich-Schiller-University of Jena, Jena, Germany.

Atherosclerotic carotid artery stenosis is relatively frequent in older patients and is a major cause of disabling stroke or death. Carotid endarterectomy is currently considered the standard of care for all patients with severe symptomatic and asymptomatic carotid stenosis. However, data regarding the efficacy of this treatment in the older patient are limited. In the past few years, carotid angioplasty and stenting have increasingly been used as an alternative to surgery. Although these endovascular techniques have the advantage of avoiding general anesthesia and surgical incisions, preliminary trial data do not support their widespread use in older patients.

Key words: carotid stenosis, carotid endarterectomy, angioplasty, stent, old age.

Mohammed Al-Omran, MD, MSc, and Yaron Sternbach, MD, Division of Vascular Surgery, Toronto General Hospital and the University of Toronto.

Arterial occlusive disease of the lower extremities is an important cause of disability in older adults and those with risk factors for atherosclerosis. The process may be asymptomatic or manifest as a progression from claudication to ulceration. Identification of patients at risk is vital to careful surveillance and early intervention. Revascularization remains the mainstay of therapy for critically ischemic limbs. Catheter-based techniques such as angioplasty are useful for focal disease. Conventional bypass surgery remains the mainstay of therapy for more extensive disease with ulceration and may be supplemented by adjunctive plastic surgery procedures for soft tissue coverage and limb salvage. Amputation is performed when reconstruction is not feasible or in the setting of severe progressive infection. The current article provides a more detailed review of lower extremity ischemia.

Key words: Peripheral arterial occlusive disease (PAOD), atherosclerosis risk factors, bypass, angioplasty, patency rates.