Sex-Based Assessment of Patient Presentation, Lesion Characteristics, and Treatment Modalities in Patients Undergoing Peripheral Vascular Intervention

Abstract

Background: Limited evidence suggests that women and men might be treated differently for peripheral arterial disease (PAD). This analysis evaluated sex-based differences in disease presentation and its effect on treatment modality among patients who underwent endovascular treatment for PAD. Methods and Results: Using national registry data from the Vascular Quality Initiative between 2010–2013, we examined patient, limb, and artery characteristics by sex through descriptive statistics. We studied 26,750 procedures performed in 23,820 patients to treat 30,545 limbs and 44,804 arteries. Women presented at an older age (69 vs 67 years, p<0.001) and were less often current or former smokers (72% vs 85%, p<0.001). TASC classification was similar among men and women (TASC C or D: 37% in men vs 37% in women, p=0.81), as was mean occlusion length (4.5cm in men vs 4.6cm in women, p=0.04), even after accounting for lesion location. Women more frequently underwent treatment for rest pain (11% in men vs 16% in women, p<0.001) versus claudication (59% in men vs 53% in women, p<0.001) or tissue loss (28% in men vs 27% in women, p=0.75). Treatment modality did not differ by sex, but was associated with disease severity (p for trend<0.001) and lesion location (p for trend<0.001). Conclusions: Women undergo PVI for PAD at an older age with critical limb ischemia. Treatment modalities do not vary by sex, but are determined by disease severity and site. While there exist sex differences in presentation, these differences do not lead to differential treatment for women with PAD.

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

“…Regarding differences in clinical presentation, it was found that female patients more often suffer from ischaemic rest pain when compared with males. This finding confirms prior results from disease registries 8,22,28 and cross sectional studies where women with PAD were more likely than men to have exertional leg pain that sometimes begins at rest. 23 Others have found women to be more prone to present with no symptoms when compared with their male counterparts.…”

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“…Female patients tend to present later and in a more urgent stage with ischaemic rest pain, while their male counterparts are revascularised electively for intermittent claudication. 15,16 The significantly lower rate of prior outpatient PAOD diagnoses in women in the current study confirms earlier disease recognition, prevention, and management in males as compared with females as reported in the literature. 49 An overall positive time trend establishes that guideline recommendations led to improving prescription rates over time.…”

Sex-related differences in outcomes after vascular interventions

“…11 However, recent reports indicate equal rates of endovascular management between men and women, 12 and that treatment type is associated with disease severity as opposed to patient sex. 13 Still, little is known about sex-specific differences in disease manifestations of PAD and how these differences in presentation impact outcomes of lower extremity intervention. Consequently, the American Heart Association (AHA) recently issued a ‘Call to Action’ to propagate research initiatives focusing on sex-specific differences in disease characteristics.…”

“…Women undergoing lower extremity revascularizations typically present at an older age and with more complex disease compared to their male counterparts. 9,13 The sex-specific differences in disease severity and age at presentation may be due to the fact that more women with PAD are asymptomatic until later in the disease process, which results in a delay to diagnosis, 14–17 or differences may be related to socioeconomic factors that prevent access to quality care. Multiple studies have demonstrated that patients with PAD are generally under-treated with guideline-recommended therapies, including antiplatelet agents and statins; this under-treatment is roughly similar between men and women with PAD.…”