Claudication in young adults: a frequently delayed diagnosis

Arterial occlusive disease of the lower extremities is uncommon in young adults. Between 1983 and 1988 we undertook an aggressive approach to the diagnosis and treatment of claudication in young patients. Thirty-three patients (30 men and three women) with the onset of significant claudication at age 40 years or younger underwent arteriography after noninvasive evaluation. The mean duration of symptoms was 2 years, and six patients had suffered claudication for 4 years or longer. Atherosclerotic occlusive disease was found in 19 patients (58%), delayed presentation of traumatic occlusion was found in four (12%), congenital arteriopathy was found in four (12%), vasculitis was found in five (15%), and one patient (3%) had normal arteriogram results despite a history and physical examination that suggested inflow disease. Management included percutaneous transluminal angioplasty (PTA) in eight patients (24%) and operative reconstruction in 17 (52%). Seven patients (21%) were treated nonoperatively (five had unreconstructible distal disease and two declined operation). During a mean follow-up of 33 months, three patients who continued to smoke required either repeat PTA or operation for recurrent disease, one patient underwent repeat aortic reconstruction for early operative failure, and one patient with vasculitis required revision of an in situ vein graft for aneurysmal dilatation. The success rates of PTA and surgical reconstruction were encouraging. However, in the group with atherosclerotic occlusive vascular disease, the inability to abstain from smoking suggests a poor prognosis for long-term success.