Long-term outcome in patients under 40 years after revascularization for chronic lower limb ischaemia.
BACKGROUND
In order to find out if surgical or endoluminal treatment changes the long-term results of atherosclerotic occlusive disease in patients of under 40 years of age we reviewed 17 consecutive patients.


METHODS
Their mean age was 36.5. Patients with Buerger's disease or inflammatory arteriopathy were excluded. All patients were extremely heavy smokers. The indications for surgical procedures were disabling claudication (less than 100 meters) for 11 patients, rest pain for 4 patients and grangrene of a lower limb for 2 patients. The lesions were aorto-iliac in 12 cases and femoro-popliteal in 5. Ten surgical procedures were performed (5 aorto-femoral bypasses, 1 ilio-femoral bypass associated with an aorto-renal bypass, 2 femoropopliteal bypasses, 1 aorto-iliac endarteriectomy, 1 femoral endarteriectomy). On the other hand there were 7 endoluminal procedures (1 aortic, 4 iliac, 1 femoral and 1 popliteal).


RESULTS
The mean follow-up was 97.3+/-50 months (range, from 34 to 216 months). Two patients died by 57 and 132 months respectively. At 5 years the survival rate was 94%; the primary patency rate was 59%; the secondary patency rate was 81% and the limb salvage rate was 94%. At 10 years these rates were respectively 94%, 44%, 54% and 75%. A total of 21 reoperations were performed. During follow-up 11 patients were better, 2 were stable and 4 were worse with 2 limbs lost.


CONCLUSIONS
These bad results suggest keeping the surgical and endoluminal indications for patients younger than 40 years with threatened limbs.
Bertrand
P
P
Department of Thoracic and Vascular Surgery, Tenon Hospital, Paris, France.
Gouny
P
P
Mercier
F
F
Cheynel-Hocquet
C
C
Duedal
V
V
Nussaume
O
O
D000328:Adult; D000800:Angioplasty, Balloon; D001158:Arteries / Q000601:surgery; D001161:Arteriosclerosis / Q000601:surgery*; D004691:Endarterectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D012008:Recurrence; D016896:Treatment Outcome