AORTOILIOFEMORAL BYPASS GRAFT IN YOUNG-ADULTS - LONG-TERM RESULTS IN A SERIES OF 68 PATIENTS

Background. The aim of this study was to investigate surgical indicati ons and the long-term outcomes of aortoliofemoral reconstructions in a dults younger than 45 year. Methods. Between 1973 and 1990, 1256 patie nts underwent infrarenal abdominal aortic reconstruction for aortoilio femoral occlusive disease. Sixty-eight (5.4 %) patients (group 1) were less than 45 years old and form the basis of the analysis. They were retrospectively compared with two additional groups of patients 45 yea rs and older selected from the entire series. Patients in group 2 (n = 100) were randomly chosen to determine differences in risk factors, a ssociated diseases, operative indications, preoperative findings, and outcomes. Patients in group 3 (n = 70) were matched with those in grou p 1 for gender, risk factors, associated diseases, preoperative findin gs, and operative indications to assess the importance of age in deter mining the short- and long-term outcomes of aortoiliofemoral reconstru ctions. Results. Postoperative mortality rates (1.5 %, 4 %, and 4.3 % for groups 2, 2, and 3, respectively) and major complication rates (4. 4 %, 7 % , and 7.1 % for groups 1, 2, and 3, respectively) were compar able among the three groups. Ten-year secondary patency rates were 84. 6 %, 70.6 %, and 80.3 %, for groups 1, 2, and 3 respectively (1, = not significant). Ten-year limb salvage rates were 86.9 %, 78.2 %, and 80 .6 %, for groups 1, 2, and 3 respectively (p = not significant). Durin g follow-up a significantly higher percentage of myocardial infarction was recorded in group 1 as compared with group 2 (p < 0.03) and group 3 (p < 0.04). The 10-year survival rate for group 1 was significantly lower than that of group 2 (29.0 % versus 46.9 %; p < 0.005). Conclus ions. Aortoliofemoral reconstruction in patients younger than 45 years is a safe procedure with low operative risks and good long-term resul ts in patency and limb salvage rates. However, life expectancy is poor because of the high incidence of deaths related to coronary artery di sease.