ORIGINAL ARTICLES  VASCULAR PAPERS 

The Journal of Cardiovascular Surgery 1999 August;40(4):561-6

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Long-term outcome in patients under 40 years after revascularization for chronic lower limb ischaemia

Bertrand P., Gouny P., Mercier F., Cheynel-Hocquet C., Duedal V., Nussaume O.

From the Department of Thoracic and Vascular Surgery Tenon Hospital, Paris, France

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 femo­ro-pop­li­teal 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.