Diagnosis and treatment of 193 cases under 45 years old with peripheral arterial disease / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To analyze the etiology, characteristics, and treatment outcomes of peripheral arterial disease (PAD) in patients under 45 years old.</p><p><b>METHODS</b>One hundred and ninety-three cases under 45 years old with PAD were included from January 1999 to January 2009. The demography, etiology, surgical data, treatment outcomes of these patients were evaluated and analyzed. Among these patients, males are 171 cases. The age was 13 to 44 years old (average age 35 years old) and the average time between onsets of PAD to admission was 3.6 months. In the 138 patients who underwent surgical interventions, 30 patients had serologically proven thrombophilia, 50 patients without thrombophilia had other definite reasons but not Burger's disease. A total of 116 cases underwent open operations, 17 cases were received endovascular interventions and 5 cases underwent combinative treatments.</p><p><b>RESULTS</b>Among the 193 patients, 140 cases (72.5%) had definite reasons. Forty patients (28.6%) were diagnosed with congenital or acquired hypercoagulability in the 140 cases. The thrombophilia group had poorer primary patency (70.0% vs. 92.0%, P = 0.010) and secondary patency (83.3% vs. 98.0%, P = 0.016) than non-thrombophilia group and more likely to underwent second revascularization because of recurrent thrombosis within 30 days after operations. After 16 months follow-up, the patients with thrombophilia had lower primary patency (65.0% vs. 75.7%, P = 0.392) and secondary patency (80.0% vs. 91.9%, P = 0.192) than the ones without thrombophilia and the rate of amputation was higher in thrombophilia group (15.0% vs. 5.4%, P = 0.222) but, these didn't achieve statistical significance.</p><p><b>CONCLUSIONS</b>A high prevalence rate of thrombophilia is found in patients less than 45 years old with PAD requiring revascularization. Thrombophilia may have contributed to early postoperative thrombosis of the vascular procedure. So the screening and medical therapy to thrombophilia in young adults with PAD should be reinforced before surgical treatment.</p>