Female Sex Is Associated with Higher Risk for Reintervention After Endovascular Interventions and Infrainguinal Bypass for Intermittent Claudication
Scott R Levin1, Alik Farber1, Elizabeth G King1, Kristina A Giles2, Mohammad H. Eslami3, Caitlin W. Hicks4, Virendra I. Patel5, Denis Rybin1, Jeffrey J. Siracuse1
1Boston Medical Center, Boston University, Boston, MA; 2Maine Medical Center, Portland, ME; 3University of Pittsburgh Medical Center, Pittsburgh, PA; 4Johns Hopkins University School of Medicine, Baltimore, MD; 5Columbia University Medical Center, New York, NY
Intermittent claudication (IC) is a commonly treated vascular condition. Patient sex has been shown to influence outcomes of interventions for other vascular disorders; however, whether outcomes of interventions for IC vary by sex is unclear.
The Vascular Quality Initiative database (2010-2020) was queried for suprainguinal (SIB) and infrainguinal (IIB) bypasses and peripheral vascular interventions (PVI) for IC. Univariable and multivariable analyses evaluated the association of sex with perioperative and one-year outcomes.
We identified 64,752 PVI (38% female), 9,314 (30% female) IIB, and 3,227 SIB (37% female) performed for IC. For PVI and IIB, female patients were less often on aspirin and statins (all P<.001). After PVI, female patients more often had access site hematomas (3.6% vs. 2.3%, P<.001) and stenosis/occlusion (0.3% vs. 0.2%, P=.001). Female patients had lower one-year reintervention-free survival (84.3% vs. 86.3%, P<.001) with no differences in amputation or death. This was confirmed on multivariable analysis. After IIB, there were no differences in perioperative outcomes. Female patients had lower one-year reintervention-free survival (79% vs 81.2%, P=.04) with no differences in amputation or death. This was confirmed on multivariable analysis. For SIB, female patients had fewer perioperative surgical site infections (0.9% vs. 1.8%, P=.048). There was no significant difference by sex for one-year reintervention, amputation, or death, even adjusted for comorbidities.
Female patients undergoing PVI and IIB for IC were less often on maximal medical therapy and had increased risk of reintervention. Future research should clarify reasons for poorer intervention durability in female patients.
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