CAROTID ATHEROSCLEROSIS IN PATIENTS OPERATED FOR LOWER-EXTREMITY ISCHEMIA BEFORE THE AGE OF 50 - A CASE-CONTROL STUDY

The purpose of this study was to investigate the presence of, and to i dentify factors associated with carotid atherosclerosis in patients, p reviously operated on for lower extremity ischemia before the age of 5 0. Forty-eight patients were compared to sex- and age-matched controls . All subjects were examined with duplex ultrasonography of the neck a rteries and analysis of serum lipoproteins. History including smoking habits, family history of cardiovascular disease, and medication was a lso obtained. The patients were examined clinically and their preopera tive angiograms were reevaluated. Thirty-one patients (64%) and 13 con trols (23%) had a carotid lesion (p < 0.0001). Patients with supraingu inal or multilevel disease had a higher proportion of carotid lesions than those with only infrainguinal disease in whom the proportion was similar to the controls. A multiple regression analysis among the pati ents revealed that age, level of lower extremity arterial disease, pre sence of family history, and the ratio apolipoproteinB/apolipoproteinA discriminated significantly between those with and without carotid di sease. It is concluded that a high proportion of patients operated on for lower extremity suprainguinal arterial occlusive disease at an ear ly age have carotid lesions at follow-up, while patients operated on d ue to isolated infrainguinal disease have a prevalence similar to cont rols.