Gender differences in endovascular treatment of infrainguinal peripheral artery disease

Abstract

Summary:Background: Despite ongoing research concerning comorbidities and clinical presentation of peripheral arterial disease (PAD), the issue of gender associated differences in treatment is far from being settled. Patients and methods: This was a prospective, non-randomized multicentre study design. All patients suffering from intermittent claudication (IC) or critical limb ischaemia (CLI) were included. Results: A total of 2,798 procedures for symptomatic PAD in the infrainguinal region were recorded, with 1,696 (61.4 %) males. Distribution of comorbidities for patients with IC were gender-specifi cally different. Smoking was more common in men (41.9 vs. 31.9 %, p < .001), men had more often previous coronary heart disease (35.2 vs. 27.7 %, p = .007), and suffered more often from diabetes (33.9 vs. 28.2 %, p = .037). Women were generally older (71 vs. 77 years). Men were more prone to present with IC (46.9 vs. 43.6 %, p < .001) and ulcer/gangrene (43.6 vs. 41.2 %, p < .001). Women were more likely to present with rest pain (9.5 vs. 15.1 %, p < .001). Men were more often treated for a lesion below the knee (BTK) (21.1 vs. 14.9 %, p < .001), and females above the knee (ATK) (58.1 vs. 61.5 %, p < .001). Logistic regression analysis revealed a signifi cant association of male gender and treatment for lesions BTK (OR 1.565, 95 % CI 1.281-1.913, p < .001). Dissections and bleeding complications were more often observed in females with IC (3.3 vs. 7.2 %, p = 0.003; 0.4 vs. 1.5 %, p = 0.044). Women were rather discharged to rehabilitation and had a longer hospital stay compared to men (3.4 vs. 8.9 %, p < .001; three vs. four days, p = .023). Conclusions: The present study provides an overview on gender-specifi c differences in endovascular treatment of PAD. To date, available evidence on this topic is limited, emphasising the importance of further vascular research targeting this topic.

Peripheral Arterial Disease in Women: an Overview of Risk Factor Profile, Clinical Features, and Outcomes

“…Women with PAD have a two- to fourfold increased risk of cardiovascular mortality and morbidity compared to women without PAD [ 15 ]. Compared to men, women are more likely to be admitted for acute myocardial infarction [ 83 ], more likely to be admitted emergently with longer hospital stays and more likely to require rehabilitation or nursing home care [ 16 •, 59 , 84 ]. Similarly, women with CLI have higher in-hospital mortality after both endovascular treatments and open surgery [ 85 ].…”

Gender variation in symptomatic peripheral arterial occlusive disease among type-2 diabetic patients

“…Peripheral arterial occlusive disease (PAOD) has become a global problem with significant impact on national healthcare systems. 1 It affects over 202 million people worldwide. 2 It is the third most common cardiovascular cause of death, after coronary heart disease and stroke.…”

Increased mortality in octogenarians treated for lifestyle limiting claudication

“…Our regression analysis demonstrated that age over 80 years, female sex, higher CCI score and having an open as opposed to an endovascular procedure were all independent predictors of in‐hospital mortality. Age over 80 years, female sex, higher CCI score and open surgery are variables that certainly have been reported as risk factors for increased mortality for any cardiac/vascular interventions .…”