Population Based Analysis of Gender Disparities in 23,715 Percutaneous Endovascular Revascularisations in the Metropolitan Area of Hamburg

Abstract

WHAT THIS PAPER ADDS This large population based study includes real world evidence from a long observation time between 2004 and 2015 and adds to the very limited knowledge base regarding gender disparities in peripheral arterial revascularisation practice. Females presented at an older age were more often treated for rest pain, and more often underwent revascularisations above the knee. Furthermore, major bleeding complications occurred more often in females, and the transferal rate to nursing homes was higher in female patients. These differences call for further research and gender related treatment recommendations in peripheral arterial disease revascularisations.Background: The worldwide prevalence of peripheral artery disease (PAD) is increasing and endovascular revascularisation (ER) has become the primary invasive treatment option. This study aims to illuminate gender disparities in ER of PAD. Methods: This is a retrospective, cross sectional study design. All inpatient invasive, percutaneous endovascular treatments of PAD conducted in the metropolitan area of Hamburg (Germany) were collected consecutively between 01/2004 and 12/2015. Relevant socio-demographic risk factors, technical assessments, procedural details, and in hospital outcomes were collected and subsequently analysed. Results: A total of 23,715 ERs were identified (39.7% females). Female patients were older (74 vs. 70 years, p < .001) and more often suffered from rest pain (12.0% vs. 9.7%, p < .001) at the time of presentation. No differences were found for index lesion complexity (Trans-Atlantic Inter-Society Consensus classes) and the ankle brachial index was less often stated not to be valid in females (5.9% vs. 7.1%, p ¼ .005 for intermittent claudication; 28.5% vs. 32.0%, p ¼ .001 for chronic limb threatening ischaemia, CLTI). If the ER was performed for CLTI, crural vessels below the knee were less often revascularised in females (32.2% vs. 42.7%, p < .001). Peri-operative major bleeding complications including pseudoaneurysms occurred twice as often in females, and female gender was an independent predictor of bleeding complications in the adjusted analyses (OR 2.32, 95% CI 1.49e3.64, p < .001 for IC; OR 1.67, 95% CI 1.10e2.53, p ¼ .017 for CLTI). Lastly, females were more often transferred to nursing homes when compared with males (0.3% vs. 0%, p ¼ .001 for IC; 2.5% vs. 1.2%, p < .001 for CLTI). Conclusion: In this study considering percutaneous ER for PAD, female patients were older, had different clinical symptoms, suffered more often from complications, and were at risk of social isolation after discharge when compared with their male counterparts. These results emphasise the need for further studies to evaluate a gender based treatment algorithm in PAD.

Editor's Choice – International Variations and Sex Disparities in the Treatment of Peripheral Arterial Occlusive Disease: A Report from VASCUNET and the International Consortium of Vascular Registries

“…21 Women are known to present at a later stage of the disease and often exhibit different or even atypical symptoms. 22,23 The current study confirmed findings from prior publications and highlighted important sex disparities that may have implications for both patients and healthcare systems. Women were approximately three years older and underwent treatment at a more advanced disease stage, which is in agreement with other studies.…”

Editor's Choice – Optimal Pharmacological Treatment of Symptomatic Peripheral Arterial Occlusive Disease and Evidence of Female Patient Disadvantage: An Analysis of Health Insurance Claims Data

“…Female patients tend to present later and in a more urgent stage with ischaemic rest pain, while their male counterparts are revascularised electively for intermittent claudication. 15,16 The significantly lower rate of prior outpatient PAOD diagnoses in women in the current study confirms earlier disease recognition, prevention, and management in males as compared with females as reported in the literature. 49 An overall positive time trend establishes that guideline recommendations led to improving prescription rates over time.…”

A health insurance claims analysis on the effect of female sex on long-term outcomes after peripheral endovascular interventions for symptomatic peripheral arterial occlusive disease

“…It had been reported that the female patients were older and had had more severe, or even atypical, symptoms when being selected for treatment. 9,12 Using the multicenter Vascular Quality Initiative registry, 30 Ramkumar et al 12 included 58,247 patients (41% women) and 66,045 ERs were performed from 2010 to 2016 in the United States. In their unmatched retrospective observational study, worse reintervention-free survival and occlusion-free survival were observed for the women during a median follow-up of 376 days.…”