Abstract
BackgroundArterial deterioration is mostly caused by atherosclerosis, which progresses with age. However, we have observed serious backgrounds or etiologies in younger patients with non-atherosclerotic diseases and deterioration of small-to-medium-sized arterial lesions. Therefore, we aimed to identify the specific features of patients aged <40 years with deterioration of small-to-medium-sized arteries.MethodsWe selected patients who were admitted to our department from 1995 to 2019 with deterioration of small-to-medium-sized arteries (aneurysms, dissection, rupture, or arterial injury/damage) and focused on the cohort aged <40 years. We examined the backgrounds or etiologies of the patients including genetic and inflammatory diseases, which might have caused the arterial deterioration.ResultsConsequently, more than half (54.1%) of the patients aged <40 years had non-atherosclerotic comorbid diseases. However, the number of deteriorated arterial lesions was higher in patients aged <40 years than in patients aged ≥40 years (3.13 vs. 1.33 lesion/patient; P = 0.011). Furthermore, the data analysis of patients with multiple arterial lesions (≥3) revealed that the younger population tended to have more specific backgrounds or etiologies, notably Ehlers-Danlos syndrome and Behçet's disease. There were no differences in the all-cause mortality and cardiovascular disease-related mortality between patients aged <40 and ≥40 years (P = 0.89 and 0.29, respectively).ConclusionsOver 50% of patients aged <40 years with deterioration of small-to-medium-sized arteries had non-atherosclerotic, specific clinical backgrounds or etiologies, including genetic and inflammatory diseases. In addition, they exhibited more arterial lesions than older patients.
Highlights
Arterial deterioration can cause catastrophic events, such as rupture or hemorrhage, which sometimes require immediate surgical intervention
We examined the following possible relevant backgrounds or etiologies as possible causes of arterial deterioration: genetic diseases, including Marfan syndrome (MS), LoeysDietz syndrome (LDS), Ehlers-Danlos syndrome (EDS), von Recklinghausen’s disease, and Osler-Weber-Rendu disease; vasculitis, including Behçet’s disease (BD), Takayasu’s vasculitis, and Churg-Strauss syndrome; and some rare etiologies, such as median arcuate ligament compression syndrome (MALS)
When operating on patients with arterial deterioration, the genetic background should be considered because some genetic diseases result in extremely fragile tissues, which may be affected during surgery
Summary
Arterial deterioration can cause catastrophic events, such as rupture or hemorrhage, which sometimes require immediate surgical intervention. Atherosclerosis causes arterial wall deterioration accompanied by various clinical features, such as calcification, plaque, tortuosity, and elongation. Small-to-Medium-Sized Arterial Deterioration Under 40 by the resultant elevated levels of inflammatory markers or blood cultures. Young patients with arterial deterioration are initially suspected of having genetic diseases, such as Marfan syndrome (MS), LoeysDietz syndrome (LDS), and Ehlers-Danlos syndrome (EDS), which are well-known hereditary connective tissue disorders that cause vascular abnormalities, which can result in aneurysms and dissection [1]. We have observed serious backgrounds or etiologies in younger patients with non-atherosclerotic diseases and deterioration of small-to-medium-sized arterial lesions. We aimed to identify the specific features of patients aged
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