Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT.
Yale School of Public Health, New Haven, CT.
Ann Vasc Surg. 2022 Nov;87:188-197. doi: 10.1016/j.avsg.2022.07.007. Epub 2022 Aug 2.
Premature peripheral artery disease (PAD), defined as ≤ 50 years of age, is associated with poor outcomes following lower extremity revascularization (LER). However, the specific characteristics and outcomes of this group of patients compared to those at the common age undergoing revascularization have not been examined. The aim of this study is to compare patients with early versus late onset premature PAD undergoing LER focusing on major adverse limb events (MALEs).
All LER procedures (open and endovascular) in the Vascular Quality Initiative (VQI) were reviewed. A histogram of patient age at the time of initial LER (no prior LER) was used to define the common age, which included all patients within one standard deviation of the mean. Characteristics and outcomes of patients with premature PAD were compared to patients treated at the common age of presentation undergoing LER.
A histogram of all patients undergoing LER was used to define 60 to 80 years as the common age. Patients with premature PAD were more likely to be female, African American, and Hispanic compared to patients at the common age. Patients with premature PAD were also more likely to have insulin-dependent diabetes, be current smokers, on dialysis, and be treated for claudication. Patients with premature PAD were less likely to have Transatlantic Intersociety Consensus (TASC II) C or D disease and were less likely to be on antiplatelets and statins. These differences were more pronounced in patients with chronic limb-threatening ischemia (CLTI). Cox proportional hazards regression demonstrated that premature PAD was independently associated with major adverse limb events (MALEs) at 1-year for patients with claudication (HR:1.7, 95% CI:1.4-2.0) and CLTI (HR:1.3, 95% CI:1.2-1.5) compared to patients 60 to 80 years of age.
Patients with premature PAD have significant differences in characteristics compared to patients treated at the common age. Vascular providers should emphasize medical therapy prior to LER given the lower rates of medical optimization and worse 1-year MALEs in patients with premature PAD.
定义为≤50 岁的早期外周动脉疾病（PAD）与下肢血运重建（LER）后的不良预后相关。然而，与接受血运重建的常见年龄患者相比，该组患者的具体特征和结局尚未得到检查。本研究的目的是比较早发性和晚发性早发性 PAD 患者接受 LER 的情况，重点是主要不良肢体事件（MALEs）。
回顾了血管质量倡议（VQI）中的所有 LER 手术（开放和血管内）。初始 LER（无先前 LER）时患者年龄的直方图用于定义常见年龄，包括平均值一个标准差内的所有患者。将早发性 PAD 患者的特征和结局与在常见年龄接受 LER 治疗的患者进行比较。
使用所有接受 LER 治疗的患者的直方图来定义 60 至 80 岁为常见年龄。与常见年龄的患者相比，早发性 PAD 患者更可能是女性、非裔美国人和西班牙裔。早发性 PAD 患者也更可能患有胰岛素依赖型糖尿病、目前吸烟、接受透析治疗和接受跛行治疗。早发性 PAD 患者 TASC II C 或 D 疾病的发生率较低，抗血小板药物和他汀类药物的使用率也较低。在慢性肢体威胁性缺血（CLTI）患者中，这些差异更为明显。Cox 比例风险回归表明，对于跛行患者（HR：1.7，95%CI：1.4-2.0）和 CLTI 患者（HR：1.3，95%CI：1.2-1.5），早发性 PAD 与 1 年时的主要不良肢体事件（MALEs）独立相关与 60 至 80 岁的患者相比。
与接受常见年龄治疗的患者相比，早发性 PAD 患者的特征存在显著差异。鉴于早发性 PAD 患者的医疗优化率较低且 1 年 MALEs 较差，血管提供者应在 LER 前强调药物治疗。
