Lower limb ischemia in young adults: prognostic implications.
Fifty patients (41 men and nine women) less than 36 years of age were evaluated for lower limb ischemia. Claudication was the presenting symptom in 30 patients (60%) and distal ulceration in 20 (40%). The mean age was 28.3 years. Premature atherosclerosis was present in 24 patients (48%) and thromboangiitis obliterans in 12 (24%). Other causes included a variety of unusual etiologies. Risk factors were analyzed. Twenty-two patients with claudication underwent arterial reconstruction; three had sympathectomy. Arterial reconstruction was possible in only three patients with ulceration; 17 had sympathectomy. No operative deaths or early amputations occurred. Follow-up averaged 13.5 years. Twenty-four patients with claudication were improved, three were unchanged, one developed ulceration, one required late amputation, and one was lost to follow-up. Four patients with ulceration were improved, one was unchanged, 14 required late amputation, and one was lost to follow-up. Ten patients, all with atherosclerosis obliterans, developed coronary artery disease; five died of myocardial infarction. No patient developed cerebrovascular disease. We conclude that reconstructive arterial surgery for claudication can be performed with low risk and a strong likelihood of long-term improvement. Most patients presenting with ulceration, however, will ultimately require amputation. Patients with atherosclerosis obliterans are at risk for coronary artery disease and death of myocardial infarction.
D000328:Adult; D000367:Age Factors; D001162:Arteriosclerosis Obliterans / Q000150:complications; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications; D007511:Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D007866:Leg / Q000098:blood supply*; D007871:Leg Ulcer / Q000150:complications; D008297:Male; D011379:Prognosis; D012306:Risk; D013919:Thromboangiitis Obliterans / Q000150:complications