The aim of this study was to determine the outcome in a consecutive series of patients over 80 years of age with limb-threatening ischaemia. The authors performed a retrospective case-note review of the treatment and outcome in 108 patients with 131 episodes of leg ischaemia, who presented to a vascular unit between 1992–1996 inclusively. Some 73 (56%) episodes of leg ischaemia occurred in patients suitable for active treatment (limb salvage 75%, amputation 4% and death 21%). Results were inferior in patients not actively treated (limb salvage 19%, amputation 50% and death 31%). Elderly patients not selected for active treatment have a very poor outcome and are seldom mentioned in publications. In future, clinical reports should include actively treated and rejected patients to avoid selection bias. Research should focus on the selection process and alternative therapies.