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Intermittent claudication caused by atherosclerosis in patients aged forty years and younger
R J Valentine1, D C MacGillivray, J W DeNobile
1Division of Vascular Surgery, National Naval Medical Center, Bethesda, Md 20814-5011.
Insights
Young patients with atherosclerotic claudication can regain military careers and improve lifestyles with angioplasty or surgery. Aggressive intervention is recommended due to high risks of premature coronary disease.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Military Medicine
Background:
- Intermittent claudication severely impacts young, active individuals, particularly military personnel.
- Atherosclerotic claudication in younger populations necessitates evaluation for career-salvaging treatments.
Purpose of the Study:
- To assess the efficacy of angioplasty and surgery in young patients with atherosclerotic claudication.
- To determine if an aggressive interventional approach is warranted for military personnel.
Main Methods:
- Systematic review of patients aged 40 years and younger with atherosclerosis and intermittent claudication.
- Analysis of arteriography, interventions (angioplasty/surgery), and follow-up outcomes.
- Assessment of associated coronary occlusive disease development.
Main Results:
- 15/22 patients had iliac artery disease; 6/22 had femoropopliteal disease.
- 85% (16/19) of patients undergoing intervention achieved complete symptom relief.
- Six patients required secondary procedures due to disease progression; 23% developed coronary artery disease.
Conclusions:
- Angioplasty and surgery can successfully return most young patients with atherosclerotic claudication to active duty.
- Aggressive interventional treatment is justified, but close monitoring for disease progression and coronary events is crucial.
Abstract:
Intermittent claudication may represent a severe limitation in daily life-style for young, active patients and may result in loss of professional career for members of the armed forces. Our recent experience with young patients with atherosclerotic claudication was reviewed to determine whether more liberal use of angioplasty and surgery is warranted in these patients to salvage their military careers and improve their life-styles. A systemic review was made of patients aged 40 years and younger with atherosclerosis who have undergone arteriography at our institution during the past 67 months. From this study, 22 patients were found with the initial complaint of intermittent claudication. Fifteen of these patients (68%) had occlusive disease confined to the iliac arteries, and six (27%) had single-level occlusive disease in a femoropopliteal distribution. Only one patient had multilevel disease. Symptoms of coronary occlusive disease developed in five patients (23%) within 38 months of the onset of claudication, and two of these patients died of myocardial infarctions. Of 19 patients who underwent interventions to correct symptoms of claudication, 16 (85%) had complete relief of symptoms at the end of follow-up, ranging from 6 months to 7 years. Ten of these patients remained symptom free after a single intervention, but six patients had rapid progression of disease and required secondary procedures. These results indicate that a majority of young patients with claudication caused by atherosclerosis can be returned to full active-duty status in the military after angioplasty or surgery. However, some patients may require secondary procedures to relieve recurrent symptoms caused by rapid progression of disease. We believe that an aggressive interventional approach is warranted in the evaluation and treatment of young patients with work-limiting claudication caused by atherosclerosis. These patients are at significant risk of developing premature coronary occlusive disease and should be monitored closely.