title: Surgical reconstruction for unilateral iliac artery lesions in patients younger than 50 years.
abstract: BACKGROUND
  To evaluate safety, short and long-term graft patency, clinical success rates, and factors associated with patency, limb salvage and mortality after surgical reconstruction in patients younger than 50 years of age who had undergone unilateral iliac artery bypass surgery.
  
  
  METHODS
  From January 2000 to January 2010, 65 consecutive reconstructive vascular operations were performed in 22 women and 43 men of age < 50 years with unilateral iliac atherosclerotic lesions and claudication or chronic limb ischemia. All patients were followed at 1, 3, 6, and 12 months after surgery and every 6 months thereafter.
  
  
  RESULTS
  There was in-hospital vascular graft thrombosis in four (6.1 %) patients. No in-hospital deaths occurred. Median follow-up was 49.6 ± 33 months. Primary patency rates at 1-, 3-, 5-, and 10-year were 92.2 %, 85.6 %, 73.6 %, and 56.5 %, respectively. Seven patients passed away during follow-up of which four patients due to coronary artery disease, two patients due to cerebrovascular disease and one patient due to malignancy. Limb salvage rate after 1-, 3-, 5-, and 10-year follow-up was 100 %, 100 %, 96.3 %, and 91.2 %, respectively. Cox regression analysis including age, sex, risk factors for vascular disease, indication for treatment, preoperative ABI, lesion length, graft diameter and type of pre-procedural lesion (stenosis/occlusion), showed that only age (beta - 0.281, expected beta 0.755, p = 0.007) and presence of diabetes mellitus during index surgery (beta - 1.292, expected beta 0.275, p = 0.026) were found to be significant predictors of diminishing graft patency during the follow-up. Presence of diabetes mellitus during index surgery (beta - 1.246, expected beta 0.291, p = 0.034) was the only variable predicting mortality.
  
  
  CONCLUSIONS
  Surgical treatment for unilateral iliac lesions in patients with premature atherosclerosis is a safe procedure with a low operative risk and acceptable long-term results. Diabetes mellitus and age at index surgery are predictive for low graft patency. Presence of diabetes is associated with decreased long-term survival.
authors.affiliation: Institute for Cardiovascular Disease, Dedinje, Belgrade, Serbia.
authors.forename: D
authors.initials: D
authors.lastname: Radak
authors.forename: S
authors.initials: S
authors.lastname: Babic
authors.forename: N
authors.initials: N
authors.lastname: Ilijevski
authors.forename: D
authors.initials: D
authors.lastname: Jocic
authors.forename: N
authors.initials: N
authors.lastname: Aleksic
authors.forename: P
authors.initials: P
authors.lastname: Gajin
authors.forename: S
authors.initials: S
authors.lastname: Tanaskovic
authors.forename: B
authors.initials: B
authors.lastname: Lozuk
authors.forename: P
authors.initials: P
authors.lastname: Otasevic
mesh_terms: D000328:Adult; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000601:surgery*; D050197:Atherosclerosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D007511:Ischemia / Q000401:mortality / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D015996:Survival Rate