[Arteriopathies of the lower extremities before 40. Their nature and prognosis]

Sixty-three patients with arteriopathies confirmed by arteriography when they were under 40 years of age were followed up for between 1 and 7 years. The arteriopathy was due to atheroma in 23 cases, to miscellaneous in 22 cases, and to Buerger's disease less frequently (18 cases), suggesting that atheroma should be suspected as being at the origin of an arteriopathy initially in young subjects. Confirmation of the basic nature of the affection is based on several criteria, the most reliable being results of angiography and the detection of associated lesions in other localizations. Histology is a decisive element, but biopsy may involve risks and results are sometimes difficult to interpret. Treatment depends more on clinical symptomatology and the localizations of arterial occlusion than on the nature of the arteriopathy. Sympathectomy is effective in distal lesions, whereas revascularization, adapted to the often small size of the vessels involved and potential impairment in distal vessel circulation, is necessary for proximal lesions. Overall prognosis is more satisfactory in Buerger's disease than in arteriopathy of atheromatous origin, rapid progression occurring in half of the latter cases.