Gender Differences in Peripheral Vascular Disease

Abstract

In the past 20 years, peripheral artery disease (PAD) has been increasingly recognized as a significant cause of morbidity and mortality in the United States. PAD has traditionally been identified as a male-dominant disease; however, recent population trends and studies in PAD suggest that women are affected at least as often as men. Women comprise a larger population of the elderly than men, as well as an increasing proportion of patients with PAD. Much of the existing research on PAD has focused on whole populations, and gender-specific data on PAD is sparse. This review focuses on gender-specific differences in presentation, management, and outcomes of PAD intervention that are important considerations for the interventional radiologist.

Peripheral Vascular Disease in Women: Therapeutic Options in 2019

“…In iliac occlusive disease, studies have shown better outcomes with PTA and stenting compared with PTA alone. Interestingly, although women tend to present at an older age with iliac disease and have more extensive occlusive disease, PVI outcomes and stent patency did not differ in women compared to men [17,20,22]. SFA lesions longer than 10 cm are best treated with PTA and stenting as studies have demonstrated better patency rates compared to PTA alone.…”

“…Indications for revascularization therapy include critical limb ischemia (CLI), rest pain, gangrene, or refractory claudication [17]. Historically, surgery had been the revascularization choice in these patients.…”

“…PVI is usually avoided in the common femoral and popliteal arteries due to the high failure rates observed in these locations; this is mainly attributed to higher flexion leading to stent fracture or dissociation [17]. For infrapopliteal lesions in CLI, balloon angioplasty is recommended as the treatment of choice with stenting reserved for refractory or calcified lesions [17,24,25]. The ACHILLES trial randomized 200 patients to stenting using a sirolimus-eluting stent (SES) or balloon angioplasty.…”

“…Once again, the enrollment of women was low with 25-33% in each arm. Irrespective of sex, it is important to note that when patients present with single vessel run off, weighing the risks and benefits of intervention is critical as the intervention itself can precipitate acute limb ischemia by embolic or thrombotic events [17,25].…”

Cardiovascular disease in women: Executive summary of the expert panel statement of women in cardiology of the hellenic cardiological society

“…Sex specific risk factors include use of oral contraceptives, history of complications during pregnancy such as intrauterine growth restriction, preeclampsia, and pregnancy-induced hypertension. In lower extremities revascularization women may be more prone to complications because of either open or endovascular revascularization; although Endovascular intervention generally in females appears to be associated with better patency rates [ 62 ].…”