Division of Vascular Surgery and Endovascular Therapy, Yale School of Medicine, New Haven, CT.
Division of Vascular and Endovascular Surgery, Stanford Hospital, Palo Alto, CA.
J Vasc Surg. 2024 Dec;80(6):1776-1785.e1. doi: 10.1016/j.jvs.2024.07.021. Epub 2024 Jul 11.
Premature peripheral arterial disease (PAD) (age ≤50 years) has been shown to negatively impact the outcomes of lower extremity revascularization (LER). Patients with premature PAD have an increased risk of major amputation compared with older patients. The primary goal of this study is to compare the frequency of reinterventions after LER in patients with premature PAD to their older counterparts with common age of presentation (ie, 60-80 years).
A retrospective review of consecutive patients undergoing LER for PAD in a single center was performed. Clinical, procedural, and socioeconomic characteristics were compared between patients with premature PAD and the older group. Perioperative and long-term outcomes were captured and compared including mortality, major amputation, reintervention rate and frequency, as well as major adverse limb events.
There were 1274 patients who underwent LER (4.3% premature, 61.8% age 60-80). Patients with premature PAD were more likely to be females of racial minorities. Notably, the mean Distressed Communities Index score was significantly higher in the premature PAD group compared with the older patients. Patients with premature PAD were significantly more likely to have end-stage renal disease but less likely to have hypertension, hyperlipidemia, and coronary artery disease compared with older patients. There was no significant difference in perioperative complications. After a mean follow-up of 5 years, patients with premature PAD were significantly more likely to undergo more frequent reinterventions compared with older patients. Kaplan-Meier curves showed similar overall survival and major adverse limb event-free survival between the two groups.
Patients with premature PAD are likely to undergo more frequent reinterventions after initial LER and have similar 5-year survival curves compared with patients at least 20 years older. Demographic and socioeconomic differences impacting patients with premature PAD, even in this relatively underpowered institutional experience, are striking and warrant further investigation.
已证实，早发性外周动脉疾病（PAD）（年龄≤50 岁）会对下肢血运重建（LER）的结局产生负面影响。与老年患者相比，早发性 PAD 患者有更高的主要截肢风险。本研究的主要目的是比较早发性 PAD 患者与年龄相仿（即 60-80 岁）的患者在 LER 后的再干预频率。
对单中心连续接受 LER 治疗 PAD 的患者进行回顾性研究。比较早发性 PAD 患者与老年组患者的临床、手术和社会经济特征。并捕获和比较围手术期和长期结局，包括死亡率、主要截肢、再干预率和频率以及主要肢体不良事件。
共有 1274 例患者接受了 LER（4.3%早发性，61.8%年龄 60-80 岁）。早发性 PAD 患者更可能为女性和少数族裔。值得注意的是，早发性 PAD 组的平均痛苦社区指数评分明显高于老年患者。与老年患者相比，早发性 PAD 患者发生终末期肾病的可能性明显更高，但高血压、高血脂和冠心病的可能性明显更低。围手术期并发症无显著差异。平均随访 5 年后，早发性 PAD 患者再干预的频率明显高于老年患者。Kaplan-Meier 曲线显示两组的总生存率和主要肢体不良事件无事件生存率相似。
与至少大 20 岁的患者相比，早发性 PAD 患者在初次 LER 后更可能需要进行更频繁的再干预，且具有相似的 5 年生存率曲线。即使在这种相对没有影响力的机构经验中，影响早发性 PAD 患者的人口统计学和社会经济差异也引人注目，值得进一步研究。
