Women and Peripheral Arterial Disease

Vavra, Ashley K.; Kibbe, Melina R.

doi:10.2217/whe.09.60

Cited by 52 publications

(40 citation statements)

References 95 publications

(194 reference statements)

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“…In a prior review by Higgins and Higgins, 15 gender-specific values were often inferred from overall prevalence. Vavra and Kibbe 24 reported the mean prevalence in men and women from 8 studies but did not apply appropriate meta-analytic techniques. Selection bias is likely an issue in assessment of PAD in field surveys and clinical trials, with the observation that elderly women are less prone to attend such examinations and more likely to refuse ankle blood pressure measurement.…”

Section: Methodological Challenges and Implications For Future Pad Rementioning

confidence: 99%

A Call to Action: Women and Peripheral Artery Disease

Hirsch

Allison²,

Gomes³

et al. 2012

Circulation

281

131

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Section: Methodological Challenges and Implications For Future Pad Rementioning

confidence: 99%

A Call to Action: Women and Peripheral Artery Disease

Hirsch

Allison²,

Gomes³

et al. 2012

Circulation

281

131

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“…

…”

mentioning

confidence: 99%

“…In addition they are less mobile and typical intermittent claudication is often missing [1]. The later onset of atherosclerosis in women can be explained in part by female sexual hormones [4]. Women seem to be protected from atherosclerotic diseases before menopause.…”

mentioning

confidence: 99%

“…In addition, guideline-recommended medical ther- women with PAD are more often asymptomatic or present with atypical symptoms compared to men [1,2,4]. This results in a delayed diagnosis and treatment.…”

mentioning

confidence: 99%

“…This results in a delayed diagnosis and treatment. Moreover because of the more advanced disease, women have a higher probability to present fi rst with critical limb ischaemia [4,[8][9][10]. We know from current data that a large amount of major amputations were performed in men and women without previous revascularisation [11].…”

mentioning

confidence: 99%

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The difference between men and women

Espinola‐Klein

2017

Vasa

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apy such as statins, anti-platelet medication, and angiotensin converting enzyme inhibitors are prescribed less frequently in women than in men [4]. Increased prevalence of asymptomatic PAD in women and less consequent risk factor management may contribute to more advanced disease and higher percentage of critical limb ischaemia at the time of diagnosis. A large publication including 1,797,885 patients (56 % male) from the USA confi rmed that women with PAD are older and more likely to present with critical limb ischaemia [8]. In contrast, in the study by Rieß et al. critical limb ischaemia with peripheral lesions was found more often in men than in women.In comparison to women men had more often interventions below the knee. This might be explained by the higher percentage of men with critical limb ischaemia and diabetes. A current publication including 12,379 patients who underwent lover extremity intervention found no gender diff erence in intervention above or below the knee [9]. Periinterventional success rates and long-term outcome seem to be similar in men and women. But female sex was associated with a higher rate of vascular access side complications such as bleeding [9,10]. Similar results are reported by Rieß et al. with signifi cantly more bleeding complications requiring revision in women than in men. This might be explained by risk factors for local complications such as older age, smaller vessel size, more calcifi ed arteries and increased number of comorbidities. In addition, in the present manuscript the percentage of obesity was higher in women than in men.Women were rather discharged to rehabilitation and had longer in-hospital stays. This could be explained by the more advanced age and the higher comorbidities of women when treated with endovascular procedures. Moreover vascular complications prolong in-hospital stays. In addition, because of advanced age women are more likely to live alone and need external help after hospital discharge.It should be remarked that there remains a selection bias in the manuscript by Rieß et al. Naturally they could only report the data from patients presented to the hospital with already diagnosed symptomatic PAD. In clinical practise Although the infl uence of gender on atherosclerosis in general is well known, there is only little information about its impact on peripheral artery disease (PAD). In particular many trials on treatment of PAD include only a small number of women [1,2]. This leads to the false assumption that PAD is mainly a male disease. In addition, women are usually older when they suff er from atherosclerotic disease and have more comorbidities, which has important implications on their treatment [1,2].Therefore the paper by Rieß et al. about gender diff erences in endovascular treatment of PAD adds important contributions to the literature [3]. They report data from 2,798 endovascular procedures conducted between September and November 2015 at 74 vascular centres in Germany. In total 61 % of the patients were male and more than half of the ...

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