Atherosclerosis and the hypoplastic aortoiliac system.

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 one man, and their ages ranged from 28 to 60 years, with an average of 43 years. Hyperlipidema was present in nine of 13 patients tested. All patients were heavy cigarrete 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 were no operative deaths and all patients were improved initially. It appears that normally occurring atherosclerosis in this portion of the aorta, along with congenital narrowing, 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 one major amputation following graft infection 1 1/2 years after operation. When progression of atherosclerosis occurs, it seems to involve the superficial femoral, carotid, and subclavian arteries.