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

Abstract

Objective: The aim of this study was to determine sex specific differences in the invasive treatment of symptomatic peripheral arterial occlusive disease (PAOD) between member states participating in the VASCUNET and International Consortium of Vascular Registries. Methods: Data on open surgical revascularisation and peripheral vascular intervention (PVI) of symptomatic PAOD from 2010 to 2017 were collected from population based administrative and registry data from 11 countries. Differences in age, sex, indication, and invasive treatment modality were analysed. Results: Data from 11 countries covering 671 million inhabitants and 1 164 497 hospitalisations (40% women, mean age 72 years, 49% with intermittent claudication, 54% treated with PVI) in Europe (including Russia), North America, Australia, and New Zealand were included. Patient selection and treatment modality varied widely for the proportion of female patients (23% in Portugal and 46% in Sweden), the proportion of patients with claudication (6% in Italy and 69% in Russia), patients’ mean age (70 years in the USA and 76 years in Italy), the proportion of octogenarians (8% in Russia and 33% in Sweden), and the proportion of PVI (24% in Russia and 88% in Italy). Numerous differences between females and males were observed in regard to patient age (72 vs. 70 years), the proportion of octogenarians (28% vs. 15%), proportion of patients with claudication (45% vs. 51%), proportion of PVI (57% vs. 51%), and length of hospital stay (7 days vs. 6 days). Conclusion: Remarkable differences regarding the proportion of peripheral vascular interventions, patients with claudication, and octogenarians were seen across countries and sexes. Future studies should address the underlying reasons for this, including the impact of national societal guidelines, reimbursement, and differences in health maintenance.

Treatment of Peripheral Arterial Occlusive Disease around the Globe: Malta

“…Open and/or hybrid surgery cases are performed in a dedicated vascular theatre by vascular surgeons; however, data is lacking on the number of purely hybrid procedures. The mean proportion of patients treated by endovascular procedures vs. open surgery between 2010 and 2017 was 68% (67-70, 95% confidence interval) in Malta [13]. This proportion was similar to that present in a number of European countries which participated in an international registry-based observation study [13].…”

“…The mean proportion of patients treated by endovascular procedures vs. open surgery between 2010 and 2017 was 68% (67-70, 95% confidence interval) in Malta [13]. This proportion was similar to that present in a number of European countries which participated in an international registry-based observation study [13]. Although Mater Dei hospital lacks a dedicated vascular hybrid theatre, plans to build one are ongoing and approval for this has already been obtained.…”

Sex Disparities in Long-Term Mortality after Paclitaxel Exposure in Patients with Peripheral Artery Disease: A Nationwide Claims-Based Cohort Study

“…While 28 RCTs in the first meta-analysis enrolled 33% females [1] and 8 RCT in the second meta-analysis enrolled 29% females [2], the current study was undertaken within a dataset more representative of everyday clinical practice that included 54% females. The latter seems more representative for the disease under study since a recent comparison of more than 1 million hospitalizations in 11 countries revealed that females represent approximately 40% (between 23% in Portugal and 46% in Sweden) of the cohort treated with both open-surgical and endovascular revascularizations [11]. A recent systematic review of 69 PAOD trials in the USA showed that females were appropriately represented in less than 16% of these trials, while the percentage of females in the underlying PAOD population was 53.1% [34].…”

“…Meanwhile, there is clear evidence of striking differences between the sexes concerning various aspects of PAOD treatments (including prevention, best medical treatment, and revascularization procedures) and outcomes [11][12][13][14][15].…”

A Divide between the Western European and the Central and Eastern European Countries in the Peripheral Vascular Field: A Narrative Review of the Literature

“…This lag was supported by a VASCUNET report showing that the proportion of endovas-cular peripheral vascular operations, compared to open procedures, was the lowest in Russia (24%), while the proportion in WECs ranged from 57% to 88%. Additionally, it was shown that the proportion of patients presenting with intermittent claudication vs. chronic limb-threatening ischemia was the highest in Russia (69%), while the average proportion in WECs was 37% [44].…”