Methodik. 47 Patienten (19 F:28 M) mit einem Durchschnittsalter von 34,983,92 Jahren wurden wegen einer symptomatischen juvenilen Arteriosklerose (JASK) gefchirurgisch behandelt. Die primre, von anderen Erkrankungen unbeeinflusste ASK wurde histologisch gesichert. Von den kardiovaskulren Risikofaktoren (RF) wurde v.a. der Nikotinabusus untersucht. Doppler- und duplexsonographische Nachkontrollen nach einer durchschnittlichen Beobachtungszeit von 6,983,85 Jahren dienten der Detektion arteriosklerotischer Rezidivverschlsse und neuer Befallsherde in anderen Gefterritorien. Ergebnisse. Die Hufigkeit der JASK im eigenen gefchirurgischen Krankengut betrug 0,36%. 97,9% der Patienten waren Raucher, 28,3% inhalierten tglich mehr als 40 Zigaretten. Die Suchtmittelexposition betrug in der Regel 20 Jahre. 31 Patienten (65,9%) wiesen 3RF auf. Prdilektionsstellen der JASK waren der aortoiliakale Abschnitt (48,9%), die Karotisstrombahn (19,1%) und die Koronararterien (14,9%), wobei 70,2% der Patienten innerhalb des Observationsintervalls von 13 Jahren Verschlussprozesse der distalen Aorta und der Aa.iliacae entwickelten. Schlussfolgerung. Die JASK verluft aggressiv und multilokulr mit Bevorzugung des aortoiliakalen Abschnitts. Es scheint eine grundstzliche Beziehung zum Tabakabusus zu bestehen. Ein genetischer Zusammenhang zwischen JASK und ACE-Gen-Polymorphismus wurde nicht gefunden.
Methods. Vascular surgery was performed on 47 patients with symptomatic JASK (19 F, 28 M; mean age: 34.983.92 years). The diagnosis of primary ASK, unaffected by other diseases, was histologically proved. Patients with other causative diseases were excluded. Of the cardiovascular risk factors (RF) the abuse of nicotine was specifically investigated. After a mean observation period of 6.983.85 years, Doppler and duplex sonography served to detect arteriosclerotic reocclusion and new foci in other vascular areas. In 29 patients and 60 healthy controls the angiotensin-converting enzyme (ACE) plasma level and the ACE gene polymorphism were determined, the first one by radioassay, the second one by polymerase chain reaction (PCR). Statistical analysis was performed by the chi-square test. Results. Of all the patients in our department, 0.36% suffered from JASK: 97.0% were smokers with 28.3% inhaling more than 40 cigarettes per day. The period of nicotine consumption usually amounted to 20 years. Thirty-one patients (65.9%) showed 3 RF. Predilection areas for JASK were the aortoiliac sector (48.9%), the carotid artery bifurcation (19.1%), and the coronary arteries (14.9%); 70.2% of the patients developed occlusions of the distal aorta and the iliac arteries within 13 years. Arterial reconstruction was performed by thrombendarterectomy (70.2%) or bypass implantation (27.7%). Intraoperative lethality was 2.1% (myocardial infarction), postoperative 8.5%; 79 reoperations were carried out (1.7 per patient), of which 63.3% were necessary in the first 3 postoperative years. After thrombendarterectomy 51.5% reocclusions occurred, after bypass implantation 69.2%. Seven patients (15.2%) had to undergo limb amputation. Postoperatively, 55% of the patients continued to smoke and 45% stopped smoking. Although the ex-smokers were more often free of symptoms and less often developed reocclusions, there was no significant relation to postoperative abuse of nicotine. Between the RF and the progression of ASK no significant correlation could be found either. The investigation of ACE plasma concentration showed increased levels in patients and controls with DD genotype; these deviations from the ID and II genotype, however, were not significant. The analysis of ACE gene polymorphism revealed no significant differences between patients and controls. There was no association between the DD genotype and the several risk factors (p=0.094). This gene constellation showed neither a relation to the progression of atherosclerosis nor to the occurrence of reocclusion (p=0.783) nor to a lack of symptoms at the time of observation (p=0.437). Conclusion. JASK is an aggressive and multilocal disease preferring the aortoiliac area. A general relation to consumption of tobacco can be assumed. A genetic correlation between JASK and ACE gene polymorphism could not be found.