Gender-related variation in the clinical presentation and outcomes of critical limb ischemia

Abstract

Critical limb ischemia (CLI) is a major cause of limb loss and mortality among patients with advanced peripheral artery disease. Our objective was to evaluate the gender-specific differences in patient characteristics and clinical outcomes among patients with CLI. We performed a retrospective analysis of 97 women and 122 men presenting with CLI who underwent angiography from 2006 to 2010. Baseline demographics, procedural details, and lesion characteristics were assessed for each patient. Kaplan–Meier analysis was used to assess long-term patient and lesion-level outcomes. Cox proportional hazard modeling was used to evaluate the relationship between gender and major adverse cardiovascular events (MACE). Compared to men, women were less likely to have a history of coronary artery disease (39% vs 54%, p = 0.02) or diabetes (57% vs 70%, p = 0.05) but had similar baseline medical therapy. At angiography, women were more likely to have significant femoropopliteal (77% vs 67%, p = 0.02) and multi-level infrainguinal disease (63% vs 51%, p = 0.02). Women were also more likely to undergo multi-vessel percutaneous intervention (69% vs 55%, p = 0.05), but had similar rates of limb salvage after percutaneous intervention or surgical bypass (HR 0.94 [95% CI 0.45–1.94], p = 0.9). During follow-up, women had higher rates of subsequent major adverse cardiovascular events (HR 1.63 [95% CI 1.01–2.63], p = 0.04). In conclusion, women with CLI are more likely to present with femoropopliteal and multi-level infrainguinal disease. Despite similar rates of limb salvage, women with CLI have an increased rate of subsequent major adverse cardiovascular events.

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

“…In a small cohort of 97 women and 122 men with PAD, McCoach et al found no difference in limb-specific outcomes, but women had more major adverse cardiovascular events after procedures to improve blood flow and to prevent amputation. 24 Using large state databases to evaluate outcomes for patients with PAD, Egorova et al showed statistically significant differences in mortality after treatment for PAD between women (4.95%) and men (4.37%) during a 6-year period. 25 In the work presented here, women had better amputation-free survival ranging from 10% to 28% across all age groups.…”

Association of dual-antiplatelet therapy with reduced major adverse cardiovascular events in patients with symptomatic peripheral arterial disease

“…This registry comprises all patients with a clinical diagnosis of PAD who underwent diagnostic angiography or therapeutic endovascular intervention, or both, at the UC Davis Medical Center between June 2006 and May 2013, as previously described. 16 At the time of data extraction, the registry included 1201 patients who underwent 1897 procedures. A total of 753 patients presented with claudication or CLI and were included in this study; the other patients in the registry included those presenting with acute limb ischemia, carotid artery stenosis, subclavian artery stenosis, or renal artery stenosis.…”

Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use is associated with reduced major adverse cardiovascular events among patients with critical limb ischemia

“…17 The study protocol was approved by the Institutional Review Board at the University of California, Davis Medical Center. All patients in the registry with CLI (N=464) were analyzed.…”