The Influence of Gender Difference on the Outcomes of Infrainguinal Bypass for Critical Limb Ischaemia in Chinese Patients

Abstract

following infrainguinal bypass for critical limb ischaemia, early results were similar in both gender groups. In the long-term, women patients suffered from significantly higher graft failure rate. However, their long-term survival and limb salvage rate remained comparable to those of men.

A Call to Action: Women and Peripheral Artery Disease

“…Despite the observation that native arterial diameters for woman are smaller than for men of the same age, 63 the published evidence base does not demonstrate a differential accuracy of stenosis assessment by gender. 64 No published studies have been designed or completed specifically to evaluate gender-based diagnostic accuracy.…”

“…Egorova et al 277 found a lower rate of procedural revascularization in women during inpatient hospitalization for PAD (46% versus 54%), although others have reported similar rates of revascularization between genders. 40 Several studies have observed that women undergoing lower extremity revascularization for PAD are older, 63,192,224,246,262 have more advanced disease, 234,262,277 and have a lower prevalence of smoking 63,246,262 than men. Hultgren et al 246 reported a higher proportion of suprainguinal procedures among women undergoing revascularization for PAD (44% versus 19%); conversely, others have reported lower rates of bypass to tibialevel outflow vessels in women.…”

“…224 These contrasts in procedural management were attributed to gender-specific patient selection criteria and anatomic disease distributions. Women with PAD have smaller tibial arteries, 63 which may be perceived as a factor that increases the technical difficulty associated with distal revascularization. Higher rates of emergent hospital admission and nursing home discharge in women with PAD have also been observed 277 and may reflect disparities in family or social support available to women who are considering elective revascularization.…”

“…63,132,221,278 In their analysis of patients with aortoiliac occlusive disease treated with a combination of surgical and endovascular techniques, Ballard and colleagues 221 found a relative risk of 4.6 for bypass or stent thrombosis in women. Green et al 143 observed a gender-specific relationship between graft size and thrombosis among patients treated with prosthetic aboveknee femoropopliteal bypass; 5-year cumulative patency rates in that report were 69.1% versus 37.9% for men with large versus small grafts and 45% for women in both graft-size categories.…”

Twenty-Year Analysis of Trends in the Incidence and In-Hospital Mortality for Lower-Extremity Arterial Thromboembolism

“…21 In terms of anatomic factors, women have been noted to have smaller native and conduit vessel sizes, both of which have been correlated with poor surgical outcomes. 22,23 Furthermore, a higher occurrence of periprocedural bleeding and infectious complications leading to higher morbidity and mortality has been demonstrated among female patients. 19,22 Although men achieved a greater absolute mortality reduction compared with women between study decades (2.25% for men versus 1.65% for women), this difference does not appear to be clinically meaningful.…”