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An 84 year old man stops twice on the way to the end of his street. The artery behind his knee is blocked. There are two ways to restore the flow. One is open surgery: an incision, a graft sewn in above and below the blockage, a general anaesthetic, a week in hospital. The other goes through a needle in the groin, a wire across the narrowing, a balloon, usually a stent, and home the next day. The open operation costs more at the start and lasts longer once it has healed. That trade is the whole decision, and in an old patient nobody has settled it. A repair that stays open for ten years is worth little to someone who will not live five, and the early risk climbs with age, frailty and heart or lung disease. The trials comparing them recruit patients fit enough to be randomised and rarely report the oldest of them separately, so what is known about those patients sits in registries and single centre series. This project lays that literature out in the order the decision is actually made. The reading comes first.
Read up on how blocked leg and aortic arteries are repaired, open and through a needle. Take one section, read the papers gathered for it, build the table that goes with it, and write that section of the review.
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