Objective To analyze the etiology,characteristics,and treatment outcomes of peripheral arterial disease (PAD) in patients under 45 years old.Methods One hundred and ninety-three cases mader 45 years old with PAD were included from January 1999 to January 2009.The demography. etiology,surgical data,treatment outcomes of these patients were evaluated and analyzed.Among these patients,males are 171 cases.The age was 13 to 44 years old (average age 35 years old) and the average time between onsets of PAD to admission was 3.6 months.In the 138 patients who underwent surgical interventions,30 patients had serologieally proven thrombophilia,50 patients without thrombophilia had other definite reasons but not Burger's disease.A total of 116 cases underwent open operations,17 cases were received endovascular interventions and 5 cases underwent combinative treatments.Results Among the 193 patients,140 cases(72.5%)had definite reafons.Forty patients(28.6%)were diagnosed with congenital or acquired hypercoagulability in the 140 cases.The thrombophilia group had poorer primary patency(70.0% vs.92.0%,P=0.010) and secondary patency(83.3% vs.98.0%,P=0.016) than non-thrombophilia group and more likely to underwent second revascularization because of recurrent thrombosis within 30 days after operations.After 16 months follow-up, the patients with thrombophilia had lower primary pateney(65.0% vs.75.7%,P=0.392) and secondary pateney(80.0%vs.91.9%,P= 0.192) than the ones without thrombophilia and the rate of ampumtion was higher in thrombophilia group (15.0% vs.5.4%.P=0.222) but,these didn't achieve statistical significance.Conclusions A high prevalence rate of thrombophilia is found in patients less than 45 years old with PAD requiring revascularization.Thrombophilia may have contributed to early postoperative thrombosis of the vascular procedure So the screening and medical therapy to thmmbophilia in young adults with PAD should be reinforced before surgical treatment.%目的 探讨青少年下肢缺血患者的病因、发病特点及诊治方法.方法 回顾性分析 1999年1月至2009年1月收治的193例年龄<45岁的下肢缺血患者的发病情况、治疗方法及手术 预后.其中男性171例,女性22例,年龄13-44岁,平均35岁,平均病程3.6个月.共138例患者行 手术治疗,其中开放手术116例,介入手术17例,联合手术5例.手术患者中诊为易栓症者30例.非易栓症但除外血栓闭塞性脉管炎50例.结果 193 例患者中,病因明确的140例,占总数的72.5%. 有明确易栓症40例,占病因明确患者总数的28.6%.易栓组术后近期通畅率明显低于非易栓组,术 后30 d内一期通畅率分别为70.0%和92.0%(P=0.010),二期通畅率分别为83.3%和98.0%(P= 0.016).术后因血栓复发行二次手术的患者比例,易栓组明显高于非易栓组(30.0%比8.0%,P=0.010).术后16个月随访结果显示,两组一期通畅率(65.0%比75.7%,P=0.392)、二期通畅率(80.0%比91.9%,P=0.192)、截肢率(15.0%比5.4%,P=0.222)差异尚无统计学意义.结论 年龄<45岁的下肢缺血患者中,合并易栓因素导致血液高凝状态的比例较高,同时伴有易栓症的患者术后极易出现血栓复发,外科干预前应对易栓因素进行全面排查并积极控制.
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