Do Women Have Worse Amputation-Free Survival Than Men Following Endovascular Procedures for Peripheral Arterial Disease? An Evaluation of the California State-Wide Database

Abstract

Objectives: Female gender has been shown to negatively affect the outcomes of surgical bypass for peripheral arterial disease (PAD). We examined gender-related disparities in outcomes of endovascular PAD procedures in a large population-based study. Methods: We used discharge data from California hospitals to identify patients who had PAD interventions during 2005 to 2009. Logistic regression was used for 12-month reintervention, and Cox proportional hazard regression was used for amputation-free survival comparisons. Results: A total of 25 635 patients had endovascular procedures (11 389 [44.4%] women). Women were more likely than men (34.5% vs 30.1%, P < .0001) to have critical limb ischemia (CLI). Twelve-month reintervention rate in women was similar to men. Amputation-free survival was better among women than men (hazard ratio 0.84, 95% confidence interval [CI] 0.76-0.93, P ¼ .0006). Conclusion: Despite presenting more frequently with CLI, women had better amputation-free survival than men following endovascular procedures. Future research should determine whether findings favor one type of PAD treatment modality over another for women.

Risk factors for major leg amputation in patients treated endovascularly due to critical limb ischaemia

“…Worse outcomes for endovascular intervention and a greater risk of leg amputation among individuals with chronic kidney disease [1,28] and in patients with an uncontrolled atherosclerosis risk factor [1-3, 8-10, 25] have previously been reported. However, in recent studies by Hedayati et al [29] and Lo et al [30], women were more likely than men to have CLI (in our study, only 21% of the patients were female, Tab. 1), but they had a similar 12-month reintervention rate, and better amputation-free survival.…”

Editor's Choice – Impact of Comorbidity, Medication, and Gender on Amputation Rate Following Revascularisation for Chronic Limb Threatening Ischaemia

“…10 Instead, the study supports the results of more recent work in this field. 11,12 Renal insufficiency has previously been identified as a risk factor for amputation and death in patients with CLTI with diabetes 30,31 ; and similarly, dialysis dependence has been determined to be a risk factor for amputation. 12 In the present study, renal insufficiency, even without dialysis dependence, doubled the risk of an adverse outcome after lower limb revascularisation for CLTI.…”

“…10 However, more recent work contradicts this, with a more favourable outcome in women than in men. 11,12 It is well established that smoking and comorbidities such as hypertension and diabetes increase the risk of CLTI, 13 whereas the relative impact of concurrent diseases on limb prognosis following revascularisation is less well known. A better understanding of this may improve patient selection and guide clinicians when evaluating patients with CLTI for invasive procedures.…”

Amputation trends for patients with lower extremity ulcers due to diabetes and peripheral artery disease using statewide data

“…Our findings are consistent with other studies of patients with both PAD and DM that demonstrated better amputation-free survival among women than among men. 26–28 …”