Occlusive Disease of the Lower Extremities in Patients 16 to 37 Years of Age

Abstract

This report is concerned with 47 patients (1.3%) from 16 to 37 years of age in our series of 3,500 patients with arterial insufficiency of the lower extremities who have been studied arterio-graphically. Reconstructive operation was employed in 38 (81%) and removed specimens were examined pathologically in 21 cases. The patients were classified into 3 categories depending upon the presence of associated diseases or conditions: Group I included 24 patients (51%) who had no associated disease or condition; Group II included 6 patients (13%) with diabetes which had its onset in childhood; Group III included 17 patients who had associated thrombophlebitis and involvements of the arteries of the upper extremities and who were considered to have the characteristic clinical manifestations of Buerger''s disease. The incidence of females (38%) in this series was almost 3 times that observed in older patients. The sex incidence was also influenced by the presence of associated disease with a higher incidence of females in Group I than in Group III, the respective figures being 46 and 29%. The incidence of Jewish patients was 4 times greater in this series than in the general hospital population. Smoking was common, ranging from 54% in Group I to 94% in Group III. Bilateral involvement was present in 81%. Arteriographic studies demonstrated segmental occlusive lesions in the aorta and iliac arteries in 32 patients (68%), 7 of whom also had associated segmental occlusive diseases in the distal arteries. In the remaining 15 patients the occlusive lesion was limited to the arteries in the leg. On this basis segmental occlusive lesions of a major artery permitting arterial reconstructive operation was demonstrated in 38 patients (81%). Histopathologic studies of the occlusive lesions revealed the characteristic findings of arteriosclerosis or atherosclerosis in the majority of cases (76%) while in the remainder they were considered to be similar to those previously described for Buerger''s disease. These lesions were encountered in all 3 clinical categories, although a higher percentage of those having the characteristic features of Buerger''s disease occurred in Group III. Aorto-iliac occlusions were demonstrated in 32 patients. Femoral, popliteal, tibial, and peroneal artery occlusion was present in 22 patients including seven with associated occlusion of the aorta and iliac arteries. The cumulative up-to-date studies show that 5 patients have died, 3 from myocardial infarction, 1 from cerebrovascular disease, and 1 from mesenteric infarction. Improvement or relief of symptoms has been maintained in 92% admitted for claudication; 100% admitted for claudication, rest pain and minor cutaneous changes; and 44% with ulceration, rest pain, and gangrene.