Thirty-one nondiabetic women with the onset of symptomatic peripheral vascular disease before the age of 46 years were studied to determine the risk factors important in the development of the disease and the natural history of the disease in a young population. Patients with vasculitis or embolic occlusion were excluded from analysis. All 31 women were smokers at the time of onset of symptoms, and cigarette use in general was heavy. Of the 31 patients, 20 (65 per cent) had hyperlipidemia and 14 (45 per cent) had hypertension; 16 (52 per cent) had positive family histories of atherosclerosis. Menstrual status did not appear significant as 27 (90 per cent) patients were premenopausal at the time of onset of the disease; of these, 11 (41 per cent) had used birth control pills. As is seen in older populations, the atherosclerosis involved more than one vascular bed, and 14 patients (45 per cent) had clinical evidence of cerebrovascular involvement. Five patients (16 per cent) had coronary artery disease. Angiographically, two groups were discernible: 21 patients (68 per cent) with localized disease of the aortoiliac system and normal distal vessels, and 10 patients (32 per cent) with diffuse atherosclerosis. There was no evidence that the aortoiliac tree was intrinsically smaller than normal. Twenty-five patients underwent surgery, and 22 had improved pulses during the immediate postoperative period. The mean follow-up for these 22 patients was 48 months. Surgical results depended on the location and severity of the disease. Thirteen of the 15 patients with proximal disease and normal distal vessels were markedly improved, whereas only one of seven patients with diffuse disease was similarly improved.
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