Long-term outcome in patients under 40 years after revascularization for chronic lower limb ischaemia
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Published on: September 22, 2020
P Bertrand1, P Gouny, F Mercier
1Department of Thoracic and Vascular Surgery, Tenon Hospital, Paris, France.
Insights
Surgical and endoluminal treatments for atherosclerotic occlusive disease in patients under 40 yielded poor long-term results, particularly for limb salvage. These interventions should be reserved for younger patients with critically threatened limbs.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- Atherosclerotic occlusive disease (AOD) affects younger individuals, necessitating evaluation of treatment outcomes.
- This study reviews 17 patients under 40 with AOD, focusing on long-term results of surgical and endoluminal interventions.
- All patients were heavy smokers, a significant risk factor for AOD.
Purpose of the Study:
- To determine if surgical or endoluminal treatment impacts long-term outcomes in patients under 40 with atherosclerotic occlusive disease.
- To evaluate the efficacy and durability of revascularization procedures in a young, high-risk population.
Main Methods:
- Retrospective review of 17 consecutive patients under 40 with AOD (mean age 36.5).
- Exclusion of Buerger's disease and inflammatory arteriopathy.
- Procedures included 10 surgical interventions (e.g., bypasses, endarteriectomy) and 7 endoluminal procedures (e.g., angioplasty, stenting) for aorto-iliac and femoro-popliteal lesions.
Main Results:
- Mean follow-up was 97.3 months.
- At 10 years, survival rate was 94%, primary patency 44%, secondary patency 54%, and limb salvage 75%.
- Significant reoperations (21) and limb loss (2) occurred, with 4 patients worsening over time.
Conclusions:
- The long-term results of surgical and endoluminal treatments for AOD in patients under 40 are suboptimal.
- These interventions should be reserved for younger patients presenting with critically threatened limbs.
- The high rates of reoperation and limb loss underscore the need for careful patient selection.
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.
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