HIV-occlusive vascular disease.
OBJECTIVE
To evaluate peripheral arterial occlusive disease in HIV-infected patients regarding clinical presentation and outcome of surgical intervention.


METHODS
Prospective clinical survey.


METHODS
Routine voluntary testing for HIV/AIDS was performed in all patients presenting to our vascular unit. HIV+ patients were enrolled in a registry and followed up prospectively.


RESULTS
We identified 154 HIV+ patients, of whom 91 (59%) presented with occlusive disease. There were 71 males and 20 females with a mean age of 44.2 years. The usual risk factors for atherosclerosis were present, but the incidence was less than reported in the classic atherosclerosis population. More than 90% of the patients presented with advanced stage vascular disease (Fontaine III/IV), which explains the high rate (31.9%) of primary amputation. Eighty-seven patients presented with lower-limb ischaemia, 2 patients with upper-limb ischaemia and 2 patients with symptomatic carotid artery stenosis. Seventy-eight procedures were performed on 72 patients, with a perioperative mortality of 6.95%. The limb salvage rate for femoro-popliteal bypass procedures was poor (36.1%), resulting in a high incidence of secondary amputations and prolonged hospital stay. Long-term mortality for the operated patients was 20% over a mean follow-up period of 15.4 months. Hypo-albuminaemia was found to be an important predictor of outcome.


CONCLUSIONS
Patients presenting with HIV-associated peripheral arterial disease should be carefully selected for intervention, taking into consideration nutritional and immune status, stage of the vascular disease and selecting the appropriate procedure.
van Marle
J
J
MediClinic Unit for Peripheral Vascular Surgery, Pretoria Academic Hospital, University of Pretoria.
Mistry
P P
PP
Botes
K
K
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001157:Arterial Occlusive Diseases / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D008297:Male; D016491:Peripheral Vascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D011446:Prospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology