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Long-term follow-up of patients with early atherosclerosis
1Department of Surgery, State University of New York at Buffalo, USA.
Insights
Early-onset peripheral vascular disease in patients under 50 leads to worse outcomes, including higher amputation rates, compared to older patients. Cerebrovascular disease showed similar good prognoses in both groups.
Area of Science:
- Vascular Surgery
- Atherosclerosis Research
- Patient Outcomes Analysis
Background:
- Premature peripheral vascular disease (PVD) may present unique challenges compared to later onset.
- Atherosclerosis, a common cause of PVD, impacts patients differently based on age of onset.
Purpose of the Study:
- To compare outcomes of early-onset atherosclerosis (patients <50 years) versus typical-onset atherosclerosis (patients >60 years).
- To evaluate differences in complications, intervention indications, disease location, and long-term results.
Main Methods:
- Retrospective comparison of patients under 50 undergoing operative intervention (1987-1992) with randomly selected patients over 60 from the same period.
- Evaluation of indications, risk factors, and early/late outcomes.
Main Results:
- Patients with early-onset aortoiliac or infrainguinal atherosclerosis had significantly higher late amputation rates (17% vs. 3.9%, p=0.02) and poorer overall outcomes.
- Patients with cerebrovascular disease in both age groups demonstrated similar favorable prognoses.
Conclusions:
- Early-onset aortoiliac or infrainguinal disease in patients under 50 is associated with poorer long-term outcomes compared to older populations.
- Age of atherosclerosis onset is a critical factor influencing patient prognosis, particularly for peripheral arterial disease.
Purpose:
Patients with premature peripheral vascular disease may respond differently than their older counterparts. To determine the impact of early onset of atherosclerosis on outcome, we decided to compare a group of these patients with a group of patients with typical onset of atherosclerosis with regard to early complications, indications for intervention, site of disease at initial presentation (aortoiliac, infrainguinal, or cerebrovascular), and long-term outcomes (secondary revascularization, amputation, and death).
Method:
All patients younger than 50 years old requiring operative intervention between 1987 and 1992 were retrospectively compared with a group of patients greater than 60 years old, randomly selected from patients who underwent operation during the same time period. Patients were evaluated and compared for indications, risk factors, and early and late outcomes.
Results:
Patients with early onset atherosclerosis at the aortoiliac or infrainguinal level had a higher late amputation rate (17% versus 3.9%, p = 0.02) and poorer overall outcome than their older cohorts. Patients with cerebrovascular disease in both cohorts had similarly good prognoses.
Conclusion:
Aortoiliac or infrainguinal disease diagnosed in patients less than 50 years of age portends a poorer outcome than does similar disease in an older patient population.