Clinical characteristics and outcome of isolated infrarenal aortic stenosis in young patients

Abstract

Objective: The objective of this study was to identify young patients with isolated infrarenal aortic atherosclerotic stenosis and to determine the clinical characteristics and midterm results of angioplasty and stenting.

Methods: Data from patients younger than 50 years with significant infrarenal aortic stenosis and at least 1 year of follow-up were prospectively collected. Patients with coexistent suprarenal or iliofemoral disease and Takayasu arteritis were excluded. All patients were treated with percutaneous transluminal angioplasty (PTA), primary stenting, or both. Pressure gradient was measured intraoperatively before and after the intervention. Every patient was monitored postoperatively with clinical examination, ankle-brachial index, and duplex ultrasound during follow-up.

Results: There were 51 patients, of whom 34 were excluded. Seventeen patients ranging in age from 37 to 49 years (mean, 43.7 years) met the study criteria, and they were all female. Fifteen patients had both history of hyperlipidemia and smoking with a mean of 53.2 pack-years. Fourteen patients were claudicants, whereas seven patients presented with distal embolization. Six patients were treated with primary stenting; four had PTA plus stent and seven had PTA alone. The length of the stenotic segments treated was <2 cm in 7, between 2 and 4 cm in 8, and >4 cm in 2. The mean follow-up for this cohort was 4.2 years. Mean pressure gradient before intervention was 49.06 ± 12.75 mm Hg, decreasing to 6.13 ± 2.06 mm Hg after intervention with a mean reduction of 42.75 ± 11.59 mm Hg. Mean ankle-brachial indices before the intervention were 0.67 ± 0.07, increasing to a mean of 0.92 ± 0.06 after the procedure. Stenosis developed in three patients during follow-up, requiring reintervention for a primary assisted patency of 100%.

Conclusions: Isolated infrarenal aortic stenosis in young patients is primarily a disease of women. Most of these patients are heavy smokers with hyperlipidemia. PTA alone or with stenting has favorable midterm results.