Arterial occlusive disease of the lower extremities: do women differ from men in occurrence of risk factors and response to invasive treatment?

Abstract

See related editorials on pages 314, 322 and 325.

The impact of gender on outcome after infrainguinal arterial reconstructions for peripheral occlusive disease

“…No other significant differences emerged between the two groups in risk factors and comorbidities, but prevalence of CLI was higher among women, reinforcing the impression that women are more likely to be referred at an older age than men and treated at a more advanced stage of ischemia. 8,23,24 The reasons for this are likely multifactorial and may include, as suggested in some reports, social isolation, more limited access to care due to financial reasons, and PAD symptoms being mistaken for osteoporosis or arthritis, which are common in such patients. 23,25 Although Ͼ50% of our patients had cardiac disease on presentation, with a high incidence of prior MI and percutaneous transluminal angioplasty/stenting or coronary artery bypass grafting, both in the series as a whole and in each group, the overall rate of perioperative nonfatal MI was only 2.5%, with a higher prevalence among women, though the difference did not reach significance (3.4% vs 1.9%; P ϭ .08).…”

“…8,23,24 The reasons for this are likely multifactorial and may include, as suggested in some reports, social isolation, more limited access to care due to financial reasons, and PAD symptoms being mistaken for osteoporosis or arthritis, which are common in such patients. 23,25 Although Ͼ50% of our patients had cardiac disease on presentation, with a high incidence of prior MI and percutaneous transluminal angioplasty/stenting or coronary artery bypass grafting, both in the series as a whole and in each group, the overall rate of perioperative nonfatal MI was only 2.5%, with a higher prevalence among women, though the difference did not reach significance (3.4% vs 1.9%; P ϭ .08). A higher frequency of (even fatal) perioperative MI in women was also reported in other analyses, even though men revealed paradoxically more cardiac dis- JOURNAL OF VASCULAR SURGERY Volume 56, Number 2 ease before surgery, but the investigators were unable to explain why more women had latent cardiac disease going undetected on routine preoperative screening and adversely affecting them postoperatively.…”

Arterial vascular disease in women

“…85,86 There is no much concern regarding the role of gender on aortoiliac reconstruction; the long-term operative outcomes appear similar across genders in routine and relatively young high-risk patients. 83,87,88 For lower extremity bypass, although individual reports might be conflicting when compiled together, [75][76][77][78][79][80][81][82]84 have not shown a significant statistical difference in patency rates, limb salvage, or overall survival between genders.…”

Sex-related disparities in intervention rates and type of intervention in patients with aortic and peripheral arterial diseases in the National Inpatient Sample Database

“…37 Considering PAD studies have shown that female sex is associated with more advanced disease, incisional complications, early graft failure, and increased risk for 30-day morbidity and mortality, female-focused studies are severely lacking. [38][39][40][41][42][43][44] Future areas of research for females with PAD should focus on biological, clinical, anatomic, and procedural characteristics. Interestingly, in this cohort, females were more likely to undergo endovascular revascularization for infrainguinal PAD than males, so this will point be particularly important to evaluate.…”