The influence of sex and aortic size on late patency after aortofemoral revascularization in young adults

Purpose: The purpose of this study was to determine whether aortic size influences late patency of aortofemoral reconstructions in men and women with premature atherosclerosis. Methods: We studied 37 consecutive young women (mean age ± SEM, 44 ± .7 years) and 36 young men (mean age 44 ± .8 years) who underwent elective operations for aortoiliac occlusive disease during the past 15 years. Clinical data from patients with occluded versus patent grafts were studied, and angiographic findings in patients with occluded versus patent grafts and in young adult patients in a control group (n = 50) who had nonatherosclerotic conditions were compared. Results: Twenty (54%) women and 17 (47%) men had limb occlusions within a mean of 31 ± 6 months. These occlusions resulted in major amputations in 17 (23%) patients. When patients with occluded versus patent grafts were compared no differences were found in age, sex, symptoms, type or number of atherosclerotic risk factors, or operative details. As a whole, patients in the study group had smaller infrarenal aortas than did patients in the control group (p = 0.009). Women with limb occlusions had smaller infrarenal aortas than did women with patent grafts (p = 0.03) or healthy female patients in the control group (p = 0.002). Men with limb occlusions had smaller infrarenal aortas than did men with patent grafts (p = 0.017) or male patients in the control group (p < 0.001). Angiographic outflow scores were not different in men or women with occluded versus patent grafts. Among all variables studied proportional hazards regression analysis indicated that only mean infrarenal aortic diameter was predictive of graft patency. Conclusions: These data suggest that late graft failure after aortofemoral reconstruction is common in young adults. Patients with premature atherosclerosis have smaller infrarenal aortas compared with young adults in a control group, making them more vulnerable to symptoms from atherosclerotic lesions. Size of the infrarenal aortic segment is a critical determinant of late graft patency regardless of sex. (J VASC SURG 1995;21:296-306.).