ATHEROSCLEROSIS AND HYPOPLASTIC AORTOILIAC SYSTEM

Abstract

Between January, 1965, and December, 1975, 204 patients (138 men and 66 women) underwent aortoiliac reconstruction for atherosclerotic occlusive disease. Eighteen patients (9%) had a hypoplastic aortoiliac segment and an analysis of these 18 patients constitutes the basis of this report. There were 17 women and 1 man, and their ages ranged from 28-60 yr with an average of 43 yr. Hyperlipidemia was present in 9 of 13 patients tested. All patients were heavy cigarette smokers and had lower extremity claudication with weak or absent pulses. Carotid or subclavian artery disease was found in 50%. Angiography demonstrated hypoplasia of the aorta distal to the renal arteries with either occlusion, diffuse narrowing, or, most often an "hourglass" stenosis. The iliac and femoral arteries also were narrowed. Reconstruction was achieved primarily by aortobilateral-iliac or femoral bypass. There no operative deaths and all patients were improved initially. Normally occurring atherosclerosis in this portion of the aorta, along with congenital narrowing, apparently accounts for symptoms at an early age. The predominence in women is a puzzle. The prognosis does not appear to be too grim. This may be due to absence of diabetes mellitus and the infrequency of coronary artery disease. All patients are still alive; there has been 1 major amputation following graft infection 1 1/2 yr after operation. When progression of atherosclerosis occurs, it seems to involve the superficial femoral, carotid, and subclavian arteries.