title: Impact of endovascular options on lower extremity revascularization in young patients.
abstract: OBJECTIVE
  This study assessed outcomes of revascularization strategies in young patients with premature arterial disease.
  
  
  METHODS
  Lower extremity revascularization outcomes from 2000 to 2008 were retrospectively compared among consecutive patients with comparable indications and procedures: age <50 years (group A) at the time of revascularization, 51 to 60 years (group B), and >60 years (control group C). Patency, limb salvage, and survival by limb or patient level were assessed by Kaplan-Meier and Cox proportional hazards analyses.
  
  
  RESULTS
  A total of 409 limbs in 298 patients were treated: 44% for claudication and 56% for critical limb ischemia (CLI). Group A patients were more likely to be smokers and have a hypercoagulable state but less likely to have diabetes and renal failure. Treatment indications were comparable among groups, and procedures were equally distributed between open surgical and endovascular interventions. Two perioperative deaths occurred in group C (2%). Mean follow-up was 29 months, and 16% of claudicant patients in group A progressed to CLI (B, 3%; C, 2%; P < .001). Overall, 2-year primary, primary assisted, and secondary patency were significantly lower in group A (50.5%, 65.2%, 68.2%; P = .045) vs B (65.7%, 81.4%, 86.8%; P = .01) and C (57.9%, 78.9%, 83.9%; P < .001). Claudicant patients in group A had an unexpectedly low 2-year freedom from major amputation after intervention of only 90%. Results were more comparable across groups for CLI. The 2-year freedom from reintervention was similar (A, 81.0%; B, 78.9%; C, 83.5%), irrespective of the indication for intervention (P = .60). Younger patients had a significantly higher 3-year survival (A, 89.5%; B, 85.3%) compared with patients aged >60 years (C, 71.4%; P = .005). The 2-year freedom from major amputation rate was significantly lower in claudicant patients in group A vs C undergoing endovascular revascularization (P = .002), but not in patients treated with open revascularization (P = .40). Predictors of loss of primary patency included age <50 years (P = .003), endovascular revascularization (P = .005), and progression from claudication to CLI (P < .001). Age <50 years was also an independent predictor of limb loss vs age >60 years (P = .05).
  
  
  CONCLUSIONS
  Endovascular options are commonly being used in young patients, especially those with claudication, but patency rates and outcomes remain very poor.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa 15213, USA. chaerra@upmc.edu
authors.forename: Cassius Iyad Ochoa
authors.initials: CI
authors.lastname: Chaar
authors.forename: Michel S
authors.initials: MS
authors.lastname: Makaroun
authors.forename: Luke K
authors.initials: LK
authors.lastname: Marone
authors.forename: Robert Y
authors.initials: RY
authors.lastname: Rhee
authors.forename: George
authors.initials: G
authors.lastname: Al-Khoury
authors.forename: Jae S
authors.initials: JS
authors.lastname: Cho
authors.forename: Steven A
authors.initials: SA
authors.lastname: Leers
authors.forename: Rabih A
authors.initials: RA
authors.lastname: Chaer
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D016009:Chi-Square Distribution; D018450:Disease Progression; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010414:Pennsylvania; D058729:Peripheral Arterial Disease / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency