Gender related Long-term Differences after Open Infrainguinal Surgery for Critical Limb Ischemia

Lejay, Anne; Schaeffer, Mickaël; Georg, Yannick; Lucereau, Benoit; Roussin, Mathieu; Girsowicz, Elie; Delay, Christophe; Schwein, Adeline; Thaveau, Fabien; Gény, Bernard; Chakfé, Nabil

doi:10.1016/j.ejvs.2015.07.014

Cited by 24 publications

(8 citation statements)

References 28 publications

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“…Lejay evaluated 269 women and 315 men with critical limb ischemia, showing that female gender was an independent factor predicting death, even with adjustment for age. 19 One result of our investigation was that Brazilian women were associated with a higher in-hospital mortality rate (112/1,000 cases versus 85/1,000 cases; p<0.05) and a higher chance of death (OR=1.36; p<0.05) due to emergency arterial occlusions.…”

Section: Discussionmentioning

confidence: 65%

In-hospital mortality in patients with acute limb ischemia over a 12-year period in the Brazilian public health-care system

et al. 2021

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Background Arterial diseases represent a severe public health problem in the 21st century. Although men have a higher overall prevalence, reports have suggested that women may exhibit atypical manifestations, be asymptomatic, and have hormonal peculiarities, resulting in worse outcomes and severe emergencies, such as acute limb ischemia (ALI). Objectives To analyze the morbidity and mortality profile of ALI emergencies in Brazil between 2008 and 2019. Methods An ecological study was carried out with secondary data from SIH/SUS, using ICD-10 code I.74 The proportions of emergency hospital admissions and in-hospital mortality rates (HMR) by gender, ethnicity, and age were extracted from the overall figures. P<0.05 was considered significant. Results From 2008 to 2019, there were 195,567 urgent hospitalizations due to ALI in Brazil, 111,145 (56.8%) of which were of men. Women had a higher HMR (112:1,000 hospitalizations) than men (85:1,000 hospitalizations) (p<0.05), and a higher chance of death (OR=1.36; p<0.05). Furthermore, mean survival was significantly higher among men (8,483/year versus 6,254/year; p<0.05). Stratified by ethnicity, women who self-identified as white (OR=1.44; p<0.05), black (OR=1.33; p<0.05), and brown (RR=1.25; p <0.05) had greater chances of death than men in the same ethnicity categories. Moreover, women over the age of 50 years had a higher chance of death, with a progressive increment in risk as age increased. Conclusions There was a trend to worse prognosis in ALI emergencies associated with women, especially in older groups. The literature shows that the reasons for these differences are still poorly investigated and more robust studies of this relevant disease in the area of vascular surgery are encouraged.

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Section: Discussionmentioning

confidence: 65%

In-hospital mortality in patients with acute limb ischemia over a 12-year period in the Brazilian public health-care system

et al. 2021

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“…Our finding of higher odds of acute graft failure in women is in agreement with the non-HD literature. 13,16,17 Despite the higher prevalence of prosthetic grafts and the higher risk of acute graft failure in women compared with men, there were no significant differences in limb loss in the short and long term. This is possibly due to strategies that promote recognition and salvage of failing and failed grafts.…”

Section: Discussionmentioning

confidence: 96%

“…Sex-based disparities have been described in the incidence of PAD, outcomes of infrainguinal bypass surgery in non-HD patients, and non-PAD-related vascular surgery performed in dialysis patients. 2,[10][11][12][13][14] However, a comprehensive delineation of outcomes according to sex in a nationally representative cohort of HD patients that could guide decision-making and risk stratification is lacking. Prior studies have been limited by small sample sizes, single-institutional sources, or absence of detail across categories of gender.…”

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confidence: 99%

Sex-based outcomes of lower extremity bypass surgery in hemodialysis patients

Arhuidese

Kernodle

Nejim

et al. 2018

Journal of Vascular Surgery

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“…Other French colleagues from the University of Strasbourg demonstrated a significantly lower survival rate at 6 years, but not at 30 days, among women compared to men undergoing infra-inguinal open surgery for CLTI. They concluded that female sex was an independent factor predicting death [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Sex-Related Differences and Factors Associated with Peri-Procedural and 1 Year Mortality in Chronic Limb-Threatening Ischemia Patients from the CLIMATE Italian Registry

Martelli

Zamboni²,

Sotgiu

et al. 2023

JPM

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Background: Identifying sex-related differences/variables associated with 30 day/1 year mortality in patients with chronic limb-threatening ischemia (CLTI). Methods: Multicenter/retrospective/observational study. A database was sent to all the Italian vascular surgeries to collect all the patients operated on for CLTI in 2019. Acute lower-limb ischemia and neuropathic-diabetic foot are not included. Follow-up: One year. Data on demographics/comorbidities, treatments/outcomes, and 30 day/1 year mortality were investigated. Results: Information on 2399 cases (69.8% men) from 36/143 (25.2%) centers. Median (IQR) age: 73 (66–80) and 79 (71–85) years for men/women, respectively (p < 0.0001). Women were more likely to be over 75 (63.2% vs. 40.1%, p = 0.0001). More men smokers (73.7% vs. 42.2%, p < 0.0001), are on hemodialysis (10.1% vs. 6.7%, p = 0.006), affected by diabetes (61.9% vs. 52.8%, p < 0.0001), dyslipidemia (69.3% vs. 61.3%, p < 0.0001), hypertension (91.8% vs. 88.5%, p = 0.011), coronaropathy (43.9% vs. 29.4%, p < 0.0001), bronchopneumopathy (37.1% vs. 25.6%, p < 0.0001), underwent more open/hybrid surgeries (37.9% vs. 28.8%, p < 0.0001), and minor amputations (22% vs. 13.7%, p < 0.0001). More women underwent endovascular revascularizations (61.6% vs. 55.2%, p = 0.004), major amputations (9.6% vs. 6.9%, p = 0.024), and obtained limb-salvage if with limited gangrene (50.8% vs. 44.9%, p = 0.017). Age > 75 (HR = 3.63, p = 0.003) is associated with 30 day mortality. Age > 75 (HR = 2.14, p < 0.0001), nephropathy (HR = 1.54, p < 0.0001), coronaropathy (HR = 1.26, p = 0.036), and infection/necrosis of the foot (dry, HR = 1.42, p = 0.040; wet, HR = 2.04, p < 0.0001) are associated with 1 year mortality. No sex-linked difference in mortality statistics. Conclusion: Women exhibit fewer comorbidities but are struck by CLTI when over 75, a factor associated with short- and mid-term mortality, explaining why mortality does not statistically differ between the sexes.

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Gender related Long-term Differences after Open Infrainguinal Surgery for Critical Limb Ischemia

Abstract: Gender-related disparity in critical limb ischemia open surgical revascularization outcomes still remains.

Cited by 24 publications

References 28 publications

In-hospital mortality in patients with acute limb ischemia over a 12-year period in the Brazilian public health-care system

In-hospital mortality in patients with acute limb ischemia over a 12-year period in the Brazilian public health-care system

Sex-based outcomes of lower extremity bypass surgery in hemodialysis patients

Sex-Related Differences and Factors Associated with Peri-Procedural and 1 Year Mortality in Chronic Limb-Threatening Ischemia Patients from the CLIMATE Italian Registry

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