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

Ballotta, Enzo; Gruppo, Mario; Lorenzetti, Renata; Piatto, Giacomo; Dagiau, Giuseppe; Toniato, Antonio

doi:10.1016/j.jvs.2012.01.040

Cited by 27 publications

(21 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is best demonstrated by the decreased amputation rates among patients aged 85 years and older. 13 As previously demonstrated, 14,2 we found that women with symptomatic PAD are older and more frequently present with CLI, compared to men. Women are more likely to have asymptomatic disease and hence a delay in diagnosis, and later intervention may be why women present more often with CLI compared to men.…”

Section: Discussionsupporting

confidence: 70%

Do Women Have Worse Amputation-Free Survival Than Men Following Endovascular Procedures for Peripheral Arterial Disease? An Evaluation of the California State-Wide Database

Hedayati

Brunson

et al. 2015

Vasc Endovascular Surg

View full text Add to dashboard Cite

Objectives: Female gender has been shown to negatively affect the outcomes of surgical bypass for peripheral arterial disease (PAD). We examined gender-related disparities in outcomes of endovascular PAD procedures in a large population-based study. Methods: We used discharge data from California hospitals to identify patients who had PAD interventions during 2005 to 2009. Logistic regression was used for 12-month reintervention, and Cox proportional hazard regression was used for amputation-free survival comparisons. Results: A total of 25 635 patients had endovascular procedures (11 389 [44.4%] women). Women were more likely than men (34.5% vs 30.1%, P < .0001) to have critical limb ischemia (CLI). Twelve-month reintervention rate in women was similar to men. Amputation-free survival was better among women than men (hazard ratio 0.84, 95% confidence interval [CI] 0.76-0.93, P ¼ .0006). Conclusion: Despite presenting more frequently with CLI, women had better amputation-free survival than men following endovascular procedures. Future research should determine whether findings favor one type of PAD treatment modality over another for women.

show abstract

Section: Discussionsupporting

confidence: 70%

Do Women Have Worse Amputation-Free Survival Than Men Following Endovascular Procedures for Peripheral Arterial Disease? An Evaluation of the California State-Wide Database

Hedayati

Brunson

et al. 2015

Vasc Endovascular Surg

View full text Add to dashboard Cite

show abstract

“…8, 27, 28 Other studies suggest comparable outcomes between men and women. 25 However, our results shed insight into an important interaction by age in these sex-related differences in the cumulative incidence of PAD, which may, in part, explain these conflicting findings. Women are at a particularly increased risk for PAD at younger ages; but at ages greater than 70 years, the PAD risk becomes more similar between sexes.…”

Section: Discussionmentioning

confidence: 76%

“…8 Guidelines from the American College of Cardiology (ACC)/American Heart Association (AHA) 2005 refer to male gender as a risk factor for PAD 24 but this was later refuted as the rates of PAD in women have been suggested to be as high as those in men. 8 More contemporary data from cohort studies 25, 26 suggest that women are older, present with more severe disease, and have inferior rates of limb salvage compared to men. 8, 27, 28 Other studies suggest comparable outcomes between men and women.…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in the Incidence of Peripheral Artery Disease in the Chronic Renal Insufficiency Cohort

Wang

Shaw

Townsend

et al. 2016

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

Background To define how the incidence of peripheral arterial disease (PAD) in chronic kidney disease (CKD) differs according to sex and age. Methods and Results The Chronic Renal Insufficiency Cohort (CRIC) is a multi-center, prospective cohort study of CKD participants. Fine and Gray methods were used to determine the cumulative incidence of PAD, defined by an ankle brachial index (ABI) < 0.90 or a confirmed PAD event, with death as a competing event. Adjusted subdistribution hazard ratios from the Fine and Gray model determined the risk of PAD according to sex. A priori, we hypothesized that the relationship between sex and cumulative incidence of PAD differed according to age. The mean age of the 3,174 participants in this study was 56.6 years and consisted of 55% males. Over a median follow-up of 5.9 years, 17.8% developed PAD, 13.0% were lost to followup and 11.1% died. Females had a 1.53-fold greater adjusted PAD risk compared to men (95% CI 1.27-1.84, p<0.001). These sex-related differences in PAD risk also differed by age (p=0.013). Women, compared to men, were at a markedly increased risk for PAD at younger ages; however, at ages greater than 70 years, the risk was similar across both sexes. Older men had a substantially greater PAD risk compared to younger men. In women, PAD risk did not vary with age. Conclusions Females with CKD have a higher PAD risk compared to males at younger ages. There is an important need to improve our understanding of the biological and clinical basis for these differences.

show abstract

“…10,11 More recent studies, including several systematic reviews, found no major differences in patency rates, amputation-free, and overall survival. 12–14 The emergence of endovascular therapy as a safe and effective adjunct to the gold standard of surgical bypass 15,16 has transformed the treatment of lower extremity PAD and angioplasty, and stenting has supplanted peripheral bypass as the most commonly performed treatment. 17,18 We therefore sought to assess sex-related differences in treatment and outcomes of lower extremity PAD associated with this shift in treatment paradigm.…”

mentioning

confidence: 99%

Presentation, treatment, and outcome differences between men and women undergoing revascularization or amputation for lower extremity peripheral arterial disease

Bensley

Dahlberg

et al. 2014

Journal of Vascular Surgery

142

View full text Add to dashboard Cite

Objective Prior studies have suggested treatment and outcome disparities between men and women for lower extremity peripheral arterial disease after surgical bypass. Given the recent shift toward endovascular therapy, which has increasingly been used to treat claudication, we sought to analyze sex disparities in presentation, revascularization, amputation, and inpatient mortality. Methods We identified individuals with intermittent claudication and critical limb ischemia (CLI) using International Classification of Diseases, Ninth Revision codes in the Nationwide Inpatient Sample from 1998 to 2009. We compared presentation at time of intervention (intermittent claudication vs CLI), procedure (open surgery vs percutaneous transluminal angioplasty or stenting vs major amputation), and in-hospital mortality for men and women. Regional and ambulatory trends were evaluated by performing a separate analysis of the State Inpatient and Ambulatory Surgery Databases from four geographically diverse states: California, Florida, Maryland, and New Jersey. Results From the Nationwide Inpatient Sample, we identified 1,797,885 patients (56% male) with intermittent claudication (26%) and CLI (74%), who underwent 1,865,999 procedures (41% open surgery, 20% percutaneous transluminal angioplasty or stenting, and 24% amputation). Women were older at the time of intervention by 3.5 years on average and more likely to present with CLI (75.9% vs 72.3%; odds ratio [OR], 1.21; 95% confidence interval [CI], 1.21–1.23; P < .01). Women were more likely to undergo endovascular procedures for both intermittent claudication (47% vs 41%; OR, 1.27; 95% CI, 1.25–1.28; P < .01) and CLI (21% vs 19%; OR, 1.14; 95% CI, 1.13–1.15; P < .01). From 1998 to 2009, major amputations declined from 18 to 11 per 100,000 in men and 16 to 7 per 100,000 in women, predating an increase in total CLI revascularization procedures that was seen starting in 2005 for both men and women. In-hospital mortality was higher in women regardless of disease severity or procedure performed even after adjusting for age and baseline comorbidities (.5% vs .2% after percutaneous transluminal angioplasty or stenting for intermittent claudication; 1.0% vs .7% after open surgery for intermittent claudication; 2.3% vs 1.6% after percutaneous transluminal angioplasty or stenting for CLI; 2.7% vs 2.2% after open surgery for CLI; P < .01 for all comparisons). Conclusions There appears to be a preference to perform endovascular over surgical revascularization among women, who are older and have more advanced disease at presentation. Percutaneous transluminal angioplasty or stenting continues to be popular and is increasingly being performed in the outpatient setting. Amputation and in-hospital mortality rates have been declining, and women now have lower amputation but higher mortality rates than men. Recent improvements in outcomes are likely the result of a combination of improved medical management and risk factor reduction.

show abstract

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

Cited by 27 publications

References 32 publications

Do Women Have Worse Amputation-Free Survival Than Men Following Endovascular Procedures for Peripheral Arterial Disease? An Evaluation of the California State-Wide Database

Do Women Have Worse Amputation-Free Survival Than Men Following Endovascular Procedures for Peripheral Arterial Disease? An Evaluation of the California State-Wide Database

Sex Differences in the Incidence of Peripheral Artery Disease in the Chronic Renal Insufficiency Cohort

Presentation, treatment, and outcome differences between men and women undergoing revascularization or amputation for lower extremity peripheral arterial disease

Contact Info

Product

Resources

About