[Risk factors of arteriopathy of the lower extremities: lipid and not lipid factors]. / Factores de riesgo de la arteriopatía de las extremidades inferiores: factores lipídicos y no lipídicos.

BACKGROUND: The role of lipoproteins as markers of peripheral arterial disease (PAD) is not well defined. METHODS: We measured both lipid and non-lipid risk factors in 51 male patients with angiographically proven PAD and in 56 control subjects. The independent association of risk factors with PAD was evaluated by means of a multiple logistic regression analysis. RESULTS: The levels of cholesterol bound to high density lipoprotein (HDLc) and to its subfraction HDL2 were lower and triglycerides were higher in patients than in control subjects (1.0 +/- 0.3 vs 1.2 +/- 0.3, p < 0.003; 0.4 +/- 0.2 vs 0.5 +/- 0.3, p < 0.03; and 1.8 +/- 1.2 vs 1.3 +/- 0.7, p < 0.02, respectively). Total cholesterol and LDLc levels were similar in both groups. In the multiple logistic regression analysis that was done with lipid parameters, a statistically significant association of triglycerides (OR = 1.73; CI95% = 1.06-2.80) and HDLc (OR = 0.15; CI95% = 0.05-0.50) with PAD was observed, while HDL subfractions and apolipoproteins were not significantly associated. In the multiple logistic regression analysis that was done with non-lipid parameters, hypertension (OR = 5.35; CI95% = 1.86-15.4) and smoking (packs-year) (OR = 1.04; CI95% = 1.10-1.06) were the only significantly associated with PAD. When lipid and non-lipid parameters were included in the regression analysis, a statistically significant association between hypertension, smoking and HDLc with PAD was observed. CONCLUSIONS: Among lipid risk factors, a low HDLc and high triglycerides, and among non-lipid risk factors hypertension and smoking, are significantly and independently associated with lower limb arteriopathy.

Aortoiliac endarterectomy in young patients.

From 1976 to 1981 a total of 304 aortoiliac thromboendarterectomies (TEA) were carried out. Of these, 47 (16%) were performed in young patients: 25 cases were done through a transperitoneal and 22 through a retroperitoneal approach. All retroperitoneal operations were unilateral. All patients were smokers. Twenty-seven patients had incapacitant claudication, 14 had rest pain and 6 had necrotic lesions. Patency rates at four years were 78% for transperitoneal TEA and 79% for retroperitoneal unilateral TEA. These patency rates compared favorably with those obtained using similar techniques in patients over 50 years of age. In this older group, similar 4 year patency rates were 85% and 82%, respectively. The morbidity and mortality of these approaches was analyzed in patients above and below the age of 50. Our results support the use of TEA in young patients with symptomatic advanced atherosclerosis and question the wisdom of limiting the use of TEA to localized segmental lesions of the aortoiliac segment.