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

Journal Circulation: Cardiovascular Interventions
Ramkumar N, Suckow BD, Brown JR, Sedrakyan A, Cronenwett JL, Goodney PP
Year Published 2018
Link to publication

Abstract

BACKGROUND:

Limited evidence suggests that women and men might be treated differently for peripheral arterial disease.
This analysis evaluated sex-based differences in disease presentation and its effect on treatment modality among patients
who underwent endovascular treatment for peripheral arterial disease.

METHODS AND RESULTS:

Using national registry data from the Vascular Quality Initiative between 2010 and 2013, we
examined patient, limb, and artery characteristics by sex through descriptive statistics. We studied 26750 procedures
performed in 23820 patients to treat 30545 limbs and 44804 arteries. Women presented at an older age (69 versus 67
years; P<0.001) and were less often current or former smokers (72% versus 85%; P<0.001). Transatlantic Inter-Society
Consensus classification was similar among men and women (Transatlantic Inter-Society Consensus C or D: 37% in men
versus 37% in women; P=0.81), as was mean occlusion length (4.5 cm in men versus 4.6 cm in women; P=0.04), even
after accounting for lesion location. Women more frequently underwent treatment for rest pain (11% in men versus 16%
in women; P<0.001) versus claudication (59% in men versus 53% in women; P<0.001) or tissue loss (28% in men versus
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 peripheral endovascular intervention for peripheral arterial disease at an older age with
critical limb ischemia. Treatment modalities do not vary by sex but are determined by disease severity and site. Although
there exist sex differences in presentation, these differences do not lead to differential treatment for women with peripheral
arterial disease.