ETIOLOGY OF PERIPHERAL ARTERIAL THROMBOEMBOLISM IN YOUNG-PATIENTS

BACKGROUND: NO prior studies have explored the etiology of peripheral arterial thromboembolic events (PATE) in younger patients. Therefore, we analyzed the sources of these events in patients <50 years of age o ver a recent 10-year period. Diagnostic and work-up strategies will be proposed based on the presence of cardiac or atherosclerotic risk fac tors. PATIENTS AND METHODS: The sources of emboli were classified as ( 1) conventional (cardiac or arterio-arterial), (2) unconventional, or (3) unknown. A statistical analysis of risk factors that, if absent, w ould suggest an unconventional cause was performed. Risk factors inclu ded those for cardiac and atherosclerotic disease: coronary artery dis ease (CAD), valvular disease, smoking, arrhythmia, hypertension, or di abetes mellitus. RESULTS: Overall, 51 patients were identified. Twenty -nine patients (57%) had unconventional causes (8 paradoxical emboli, 4 possible paradoxical emboli, 12 hypercoagulable states, 3 white clot syndromes, and 2 cervical ribs), 17 (33%) had conventional causes, an d 5 (10%) were unknown. When the number of cardiac risk factors was II , excluding smoking, the probability of a conventional source was zero , in contrast to 100% if the number of risk factors was >1. When the f ollowing risk factors were absent, there were significantly more uncon ventional than conventional sources of emboli (P <0.001): smoking (100 % versus 0%), CAD (93% versus 7%), arrhythmias (83% versus 17%), hyper tension (93% versus 7%), and diabetes mellitus (81% versus 19%). Patie nts with a conventional source were significantly older (44 versus 38 years). CONCLUSIONS: The ''unconventional'' causes of FATE were respon sible for a higher percentage of cases in young patients. An analysis of the number of risk factors was useful in predicting which patients suffered embolic events from conventional sources, with the critical n umber being >1 (excluding smoking). Therefore, when younger patients p resent with FATE, and are found to have II identifiable cardiac risk f actor, their work-up should be directed toward the unconventional sour ces first. Am J Surg. 1998;176: 158-161. (C) 1998 by Excerpta Medica, Inc.