Long-term outcome in patients under 40 years after revascularization for chronic lower limb ischaemia

Background. In order to find. out if surgical or endoluminal treatment chan ges the long-term results of atherosclerotic occlusive disease in patients of under 40 years of age we reviewed 17 consecutive patients. Methods, Their mean age was 36.5, Patients with Buerger's disease or inflam matory arteriopathy were excluded. All patients were extremely heavy smoker s. The indications for surgical procedures were disabling claudication (les s than 100 meters) for 11 patients, rest pain for 4 patients and grangrene of a lower Limb for 2 patients. The lesions were aorto-iliac in 12 cases an d femoro-popliteal in 5, Ten surgical procedures were performed (5 aorto-fe moral bypasses, 1 ilio-femoral bypass associated with an aorto-renal bypass , 2 femoropopliteal bypasses, 1 aorto-iliac endarteriectomy, 1 femoral enda rteriectomy). On the other hand there were 7 endoluminal procedures (1 aort ic, 4 iliac, 1 femoral and 1 popliteal). Results, The mean follow-up was 97.3+/-50 months (range, from 34 to 216 mon ths), Two patients died by 57 and 132 months respectively, At 5 years the s urvival rate was 94%; the primary patency rate was 59%; the secondary paten cy rate was 81% and the limb salvage rate was 94%, At 10 years these rates were respectively 94%, 44%, 54% and 75%, A total of 21 reoperations were pe rformed. During follow-up 11 patients were better, 2 were stable and 4 were worse with 2 limbs lost. Conclusions. These bad results suggest keeping the surgical and endoluminal indications for patients younger than 40 years with threatened limbs.