Sex-Based Differences in Periprocedural Complications Following Lower Extremity Peripheral Vascular Intervention

Abstract

Background: Women with coronary artery disease are shown to have worse outcomes after percutaneous coronary intervention compared with men; however, less is known about sex-based outcomes following lower extremity peripheral vascular intervention (PVI) for symptomatic peripheral artery disease. The study aims to assess whether female sex is independently associated with periprocedural complications in patients undergoing PVI. Methods: Analysis includes patients undergoing lower extremity PVI from September 2016 to March 2020 from the Vascular Quality Initiative registry. Multivariate logistic regression was used to assess the independent association of female sex with post-PVI complications. Results: Of the 119 620 patients included, 47 316 (39.6%) were women. Analysis reflected that women were at higher risk of developing access site complications, including any hematoma (odds ratio [OR], 1.45 [1.35–1.57]), hematoma requiring transfusion (OR, 2.24 [1.82–2.76]; P <0.001), hematoma requiring surgery (OR, 1.49 [1.19–1.86]; P <0.001), pseudoaneurysm (OR, 1.69 [1.39–2.05]; P <0.001), and access site occlusion (OR, 1.89 [1.15–3.08]; P <0.001). Women also faced higher risks of target lesion dissection (OR, 1.36 [1.26–1.46]; P <0.001), above-knee amputation (OR, 1.37 [1.18–1.58]; P <0.001), and in-hospital mortality (OR, 1.21 [1.07–1.38]; P =0.003). Conclusions: In a contemporary cohort, women undergoing lower extremity PVI for symptomatic peripheral artery disease were at higher risk than men of developing periprocedural complications, including moderate or severe access site bleeding, above-knee amputation, and in-hospital mortality. This increased risk persisted despite adjustment for differences in baseline patient or procedural characteristics and warrants further investigation.

Sex and Racial Disparities in Peripheral Artery Disease

“…93 A study that aimed to assess whether female sex is independently associated with periprocedural complications in patients undergoing lower extremity peripheral vascular intervention by utilizing data from the Vascular Quality Initiative registry found that women were at higher risk of developing access site complications (odds ratio, 1.45 [95% CI, 1.35-1.57]; P<0.001) and had a higher risk of target lesion dissection (odds ratio, 1.36 [95% CI, 1.26-1.46]; P<0.001), above-knee amputation (odds ratio, 1.37 [95% CI, 1.18-1.58]; P<0.001), and inhospital mortality (odds ratio, 1.21 [95% CI, 1.07-1.38]; P=0.003). 94 Compared with men in the Vascular Quality Initiative over the study period, women were more likely to be Black (19.6% versus 14.6%, P<0.0010), Hispanic or Latino (6.7% versus 5.9%, P<0.001), and have obesity. Compared with men, women were less likely to be on ACE (angiotensin-converting enzyme) inhibitor/ARB (angiotensin receptor blockers), antiplatelet, oral anticoagulant, cilostazol, or statin therapy at admission.…”

“…Compared with men, women were less likely to be on ACE (angiotensin-converting enzyme) inhibitor/ARB (angiotensin receptor blockers), antiplatelet, oral anticoagulant, cilostazol, or statin therapy at admission. 94 In a post hoc analysis, investigators aimed to evaluate sex-specific differences in MACE and limb events in the EUCLID trial. 66 They found that PAD severity and medical treatment were comparable between sexes, but prior lower extremity revascularization was reported less frequently in women (54.8% versus 57.3%, P=0.006).…”

“…Compared with men, women were less likely to be on ACE (angiotensin-converting enzyme) inhibitor/ARB (angiotensin receptor blockers), antiplatelet, oral anticoagulant, cilostazol, or statin therapy at admission. 94…”

Sex-Based Differences in Clinical Characteristics and Outcomes among Patients with Peripheral Artery Disease: A Retrospective Analysis

“…Furthermore, women with PAD, compared to men, have poorer quality of life because they are older, with multiple vessel involvement and more advanced disease [15]. In addition, studies demonstrated that women with symptomatic PAD were less likely to receive goal-directed medical therapy and showed a lower rate of open surgical revascularizations compared with men [16], while data about post-revascularization outcomes showed mixed results between the two sexes, with a higher risk of developing periprocedural complications after percutaneous revascularizations in female patients [17].…”

Sex-Based Differences in Clinical Characteristics and Outcomes Among Patients with Peripheral Artery Disease: A Retrospective Analysis

“…Furthermore, women with PAD, compared to men, have poorer quality of life because they are older, with multiple vessel involvement and a more advanced disease [15]. In addition, studies demonstrated that women with symptomatic PAD were less likely to receive goal-directed medical therapy and showed a lower rate of open surgical revascularizations compared with men [16], while data about postrevascularization outcomes showed mixed results between the two sexes, with a higher risk of developing periprocedural complications after percutaneous revascularizations in female patients [17].…”