Radiation Dosage for Percutaneous PAD Treatment is Different in Cardiovascular Disciplines: Results From an Eleven Year Population Based Registry in the Metropolitan Area of Hamburg

Behrendt, Christian‐Alexander; Rieß, Henrik; Heidemann, Franziska; Diener, Holger; Rohlffs, Fiona; Hohnhold, Ralf; Debus, Eike Sebastian

doi:10.1016/j.ejvs.2016.11.001

Cited by 14 publications

(4 citation statements)

References 21 publications

(18 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…External validity was reported to be 91.8%e99.1% from 2010 to 2014. 7 For this study, information was collected on patient age (in years), gender (female vs. male), coding of diabetes according to the World Health Organisation (WHO) International Classification of Diseases (ICD) codes (E10*, E11*, E12*, E13*, E14*), principal indication for the procedure, revascularisation (procedure) of crural vessels performed below the knee (BTK), disease severity score, treadmill test conducted before the procedure, ankle brachial index (ABI) before and after the procedure, ABI measured but stated as not valid, admission date, procedure date, early unsuccessful termination of the procedure, dose area product in Gy*cm, 2 discharge date and discharge destination, postoperative length of stay, and post-procedural complications.…”

Section: Methodsmentioning

confidence: 99%

“…5,6 There is evidence of a higher radiation dose and more bleeding complications in females following percutaneous ERs conducted by various interventional medical specialties when compared with their male counterparts. 7,8 In another recently published study, the authors revealed remarkably high bleeding and transfusion rates in females following complex endovascular aortic repair when compared with males, underlining the need to look into this potentially underreported adverse event. 9 To date, gender disparities in multidisciplinary cardiovascular care are controversial but there is evidence of worse outcomes in females following various procedures.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Behrendt

Bischoff

Schwaneberg

et al. 2019

European Journal of Vascular and Endovascular Surgery

View full text Add to dashboard Cite

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.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Behrendt

Bischoff

Schwaneberg

et al. 2019

European Journal of Vascular and Endovascular Surgery

View full text Add to dashboard Cite

show abstract

“…We recently published data from 24,000 percutaneous endovascular revascularizations conducted between 2004 and 2015 in the metropolitan area of Hamburg (Germany). A gender-specifi c comparison of radiation dosage (dose-area product) showed a higher exposure to ionizing radiation in men, which may be due to a more aggressive endovascular treatment [16]. Diff erences in gender-specifi c clinical symptoms and their infl uence on ER techniques were discussed as a possible explanation.…”

Section: Discussionmentioning

confidence: 99%

Gender differences in endovascular treatment of infrainguinal peripheral artery disease

Rieß

Debus

Heidemann

et al. 2017

Vasa

View full text Add to dashboard Cite

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.

show abstract

“…Factors including length of lesion, ambiguity of the proximal cap and heavy calcification limit success rates . Furthermore, these procedures are often lengthy and require increased contrast and radiation . Advances in available CTO crossing technology and operator experience have increased percutaneous intervention success rates …”

Section: Discussionmentioning

confidence: 99%

Stent crush: A novel endovascular approach for treatment of complex in‐stent femoropopliteal chronic total occlusion

Tabaza

Janzer

George

2019

Cathet Cardio Intervent

View full text Add to dashboard Cite

Femoropopliteal in-stent chronic total occlusions (CTOs) remain one of the most challenging subsets of peripheral arterial disease to treat percutaneously. Advances in available CTO crossing technology and operator experience have increased percutaneous intervention success rates. We report a case of critical limb ischemia in a patient with chronically occluded femoropopliteal nonoverlapping stents treated with a novel percutaneous approach of subintimal retrograde angioplasty using high compression resistant nitinol stents to crush the occluded previous stents to create a neo-lumen. K E Y W O R D Scritical limb ischemia, endovascular intervention, interventional devices/innovation, peripheral arterial disease, stenting technique

show abstract

Radiation Dosage for Percutaneous PAD Treatment is Different in Cardiovascular Disciplines: Results From an Eleven Year Population Based Registry in the Metropolitan Area of Hamburg

Cited by 14 publications

References 21 publications

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

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

Gender differences in endovascular treatment of infrainguinal peripheral artery disease

Stent crush: A novel endovascular approach for treatment of complex in‐stent femoropopliteal chronic total occlusion

Contact Info

Product

Resources

About