Related Experiment Videos
Aorto-iliac occlusive disease in the different population groups--clinical pattern, risk profile and results of
T E Madiba1, M Mars, J V Robbs
1Department of Surgery, University of Natal, Durban.
Insights
Atherosclerotic disease presentation and outcomes differ significantly across racial groups in Durban. Black patients often present with advanced limb-threatening disease, while whites have better surgical outcomes.
Area of Science:
- Vascular Surgery
- Epidemiology
- Cardiovascular Disease
Background:
- Atherosclerotic disease was historically considered uncommon in Black populations globally.
- Recent evidence indicates a rising prevalence of atherosclerotic disease in Black individuals.
- This study investigates disparities in atherosclerotic disease presentation and outcomes among different racial groups in Durban.
Purpose of the Study:
- To assess the clinical patterns of atherosclerotic disease in various population groups.
- To identify and compare risk profiles associated with atherosclerotic disease.
- To evaluate the results of surgical reconstruction for aorto-iliac occlusive disease.
Main Methods:
- Prospective study of 688 patients with aorto-iliac occlusive disease over 9 years.
- Comparison of clinical patterns and risk factors across Black, White, and Indian populations.
- Analysis of aortobifemoral bypass outcomes in 492 patients.
Main Results:
- Black patients presented more frequently with gangrene and threatened limbs compared to Whites, who typically presented with claudication.
- Hypertension and diabetes were common risk factors across all groups; ischemic heart disease was noted in Whites and Indians but not Blacks.
- Five-year cumulative patency rates were highest in Whites (92%), followed by Indians (77%) and Blacks (74%).
Conclusions:
- White patients demonstrated significantly better outcomes than Black patients, who presented with more advanced disease.
- Ischemic heart disease in White and Indian populations contributed to higher mortality rates in these groups.
- Racial disparities exist in the presentation, risk factors, and surgical outcomes of atherosclerotic disease.
Background:
It has previously been accepted that atherosclerotic disease is uncommon among blacks worldwide; however, recent studies have increasingly reported atherosclerotic disease in this group.
Study Design:
Prospective study of hospital patients with aorto-iliac occlusive disease presenting to the vascular service of the Durban metropolitan hospitals. The study was designed to assess clinical pattern, risk profile and results of reconstruction in these patients.
Methods:
This is a study of 688 patients with aorto-iliac occlusive disease managed over 9 years in Durban, with clinical pattern and risk factors compared in the different population groups. A subgroup of 492 patients underwent aortobifemoral bypass, providing material for comparison of the results of reconstruction in the different population groups.
Results:
More black patients presented with gangrene and threatened limb, whereas whites tended to present early with claudication. All groups had hypertension and diabetes as risk factors. In addition, whites and Indians had ischaemic heart disease, which was not found among blacks. Mortality was 5% (blacks 1.8%, whites 8.5%, Indians 5%). Medium-term occlusion rates were 19% in blacks, 13% in Indians and 5% among whites. Five-year cumulative patency rates were 92% for whites, 77% for Indians and 74% for blacks.
Conclusion:
Whites do significantly better than blacks, who tend to present at an advanced stage of the disease. The presence of ischaemic heart disease among whites and Indians contributes to the higher mortality in these groups.