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Young women with advanced aortoiliac occlusive disease: new insights
P J Gagne1, M J Vitti, L M Fink
1Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, USA.
Insights
Young women with premature aortoiliac atherosclerosis show unique hemostatic profiles, particularly elevated anticardiolipin antibodies and D-dimer levels. These findings may explain their high incidence of thromboembolic events and surgical complications.
Area of Science:
- Vascular Medicine
- Hematology
- Cardiovascular Research
Background:
- Premature atherosclerotic aortoiliac occlusive disease is rare in young women.
- These patients often present with acute thromboembolic events.
- Surgical interventions for this condition can be complicated by early thrombosis.
Purpose of the Study:
- To identify distinguishing hemostatic characteristics in young women with premature atherosclerotic aortoiliac occlusive disease.
- To investigate potential underlying hemostatic profiles contributing to their clinical presentation.
- To compare hemostatic markers between affected young women, healthy controls, and older male patients.
Main Methods:
- Assessed hemostatic markers including antiphospholipid antibodies, D-dimer, and coagulation factors in 24 young women with the condition.
- Compared these markers to 21 age-matched female controls and 9 older male patients with aortoiliac occlusive disease.
- Analyzed the incidence of thromboembolic events and surgical complications.
Main Results:
- Elevated anticardiolipin antibodies (42%) and D-dimer levels (62.5%) were significantly observed in young female patients.
- Thromboembolic events were common (62%) at presentation.
- Early graft thrombosis complicated 30% of surgical reconstructions.
Conclusions:
- A unique pattern of premature aortoiliac atherosclerosis exists in some young women.
- Intra-arterial thromboembolic events are frequent and complicate surgical management.
- The role of antiphospholipid antibodies in this specific patient group requires further investigation.
Abstract:
We identified a group of 24 young (less than 50 years of age) women with isolated, premature atherosclerotic aortoiliac occlusive disease and attempted to identify distinguishing hemostatic characteristics. Most of these patients (62%) presented with acute thromboembolic events (blue toe syndrome, n = 6; macroemboli, n = 6; or aortoiliac thrombosis, n = 3). Aortoiliac reconstruction (aortoiliac endarterectomy, n = 10, aortobifurcation bypass grafts, n = 6; and percutaneous angioplasty, n = 4) was complicated by early thrombosis in 6 of 20 cases (30%), (1 of 10 endarterectomies, 4 of 6 bypass grafts, and 1 of 4 angioplasties). Fresh thrombus overlying an atherosclerotic plaque was a common finding at surgery. This observation and the relatively high incidence of thromboembolic events led us to hypothesize that a characteristic hemostatic profile might underlie the remarkably similar clinical presentations of these women. Levels of antiphospholipid antibodies (anticardiolipin antibodies and lupus anticoagulant), plasminogen activator inhibitor-1, fibrinogen, antithrombin III, protein C, protein S, plasminogen, prothrombin fragment F1 + 2, and D-dimer were determined for these young women and for 21 age-matched white female control subjects without vascular disease and nine white male patients with aortoiliac occlusive disease (mean 61 years, range 43 to 74 years). The incidence of anticardiolipin antibodies was 42% (8 of 19) in the female patients, which was significantly elevated (p = 0.028). The female (62.5%) and male (100%) patients had significantly elevated D-dimer levels (p < 0.001). Deficiencies of antithrombin III, protein C, and protein S were rare. A unique pattern of premature aortoiliac atherosclerosis exists in some young women. Intra-arterial thromboembolic events are common at presentation and complicate surgical management. The role of antiphospholipid antibodies remains uncertain.