Female Sex is Associated with More Reinterventions After Endovascular and Open Interventions for Intermittent Claudication

Overview

Journal Ann Vasc Surg

Publisher Elsevier

Specialties Cardiology & Vascular Diseases
General Surgery

Date 2022 Jul 9

PMID 35809741

Authors

Scott R Levin

Alik Farber

Elizabeth G King

Kristina A Giles

Mohammad H Eslami

Virendra I Patel

Caitlin W Hicks

Denis Rybin

Jeffrey J Siracuse

Affiliations

Soon will be listed here.

Abstract

Background: 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. We sought to assess the association of patient sex with outcomes after IC interventions.

Methods: The Vascular Quality Initiative was queried from 2010-2020 for all peripheral endovascular interventions (PVI), infra-inguinal bypasses (IIB), and supra-inguinal bypasses (SIB) for any degree IC. Univariable and multivariable analyses compared peri-operative and long-term outcomes by patient sex.

Results: There were 24,701 female and 40,051 male patients undergoing PVI, 2,789 female and 6,525 male patients undergoing IIB, and 1,695 female and 2,370 male patients undergoing SIB for IC. Guideline-recommended pre-operative medical therapy differed with female patients less often prescribed aspirin for PVI (73.4% vs. 77.3%), IIB (71.5% vs. 74.8%), and SIB (70.9% vs. 74.3%) or statins for PVI (71.8% vs. 76.7%) and IIB (73.1% vs. 76.0%) (all P < 0.05). Female compared with male patients had lower 1-year reintervention-free survival after PVI (84.4% ± 0.3% vs. 86.3% ± 0.2%, P < 0.001), IIB (79.0% ± 0.9% vs. 81.2% ± 0.6%, P = 0.04), and SIB (89.4% ± 0.9% vs. 92.6% ± 0.7%, P = 0.005), but similar amputation-free survival and survival across all procedures. Multivariable analysis confirmed that female sex was associated with increased 1-year reintervention for PVI (HR 1.16, 95% CI 1.09-1.24, P < 0.001), IIB, (HR 1.16, 95% CI 1.03-1.31, P = 0.02), and SIB (HR 1.60, 95% CI 1.20-2.13, P = 0.001).

Conclusions: Female patients undergoing interventions for IC were less often pre-operatively medically optimized than male patients, though the difference was small. Furthermore, female sex was associated with more reinterventions after interventions. Interventionists treating female patients should increase their efforts to maximize medical therapy. Future research should clarify reasons for poorer intervention durability in female patients.

References

Wang J, He Y, Shu C, Zhao J, Dubois L . The effect of gender on outcomes after lower extremity revascularization. J Vasc Surg. 2017; 65(3):889-906.e4. DOI: 10.1016/j.jvs.2016.11.030. View

Enriquez J, Pratap P, Zbilut J, Calvin J, Volgman A . Women tolerate drug therapy for coronary artery disease as well as men do, but are treated less frequently with aspirin, beta-blockers, or statins. Gend Med. 2008; 5(1):53-61. DOI: 10.1016/s1550-8579(08)80008-3. View

Siracuse J, Woodson J, Ellis R, Farber A, Roddy S, Kalesan B . Intermittent claudication treatment patterns in the commercially insured non-Medicare population. J Vasc Surg. 2021; 74(2):499-504. DOI: 10.1016/j.jvs.2020.10.090. View

Wang L, Locham S, Dakour-Aridi H, Lillemoe K, Clary B, Malas M . Sex Disparity in Outcomes of Ruptured Abdominal Aortic Aneurysm Repair Driven by In-hospital Treatment Delays. Ann Surg. 2019; 270(4):630-638. DOI: 10.1097/SLA.0000000000003482. View

Lo R, Bensley R, Dahlberg S, Matyal R, Hamdan A, Wyers M . Presentation, treatment, and outcome differences between men and women undergoing revascularization or amputation for lower extremity peripheral arterial disease. J Vasc Surg. 2013; 59(2):409-418.e3. PMC: 3946884. DOI: 10.1016/j.jvs.2013.07.114. View

Conte M, Pomposelli F, Clair D, Geraghty P, McKinsey J, Mills J . Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg. 2015; 61(3 Suppl):2S-41S. DOI: 10.1016/j.jvs.2014.12.009. View

de Guerre L, Varkevisser R, Swerdlow N, Liang P, Li C, Dansey K . Sex differences in perioperative outcomes after complex abdominal aortic aneurysm repair. J Vasc Surg. 2019; 71(2):374-381. PMC: 6942245. DOI: 10.1016/j.jvs.2019.04.479. View

Gober L, Bui A, Ruddy J . Racial and Gender Disparity in Achieving Optimal Medical Therapy for Inpatients with Peripheral Artery Disease. Ann Vasc Med Res. 2021; 7(4). PMC: 7877491. View

Arhuidese I, Kernodle A, Nejim B, Locham S, Hicks C, Malas M . Sex-based outcomes of lower extremity bypass surgery in hemodialysis patients. J Vasc Surg. 2017; 68(1):153-160. DOI: 10.1016/j.jvs.2017.10.063. View

10.

Abuful A, Gidron Y, Henkin Y . Physicians' attitudes toward preventive therapy for coronary artery disease: is there a gender bias?. Clin Cardiol. 2005; 28(8):389-93. PMC: 6654010. DOI: 10.1002/clc.4960280809. View

11.

Jones D, Goodney P, Eldrup-Jorgensen J, Schermerhorn M, Siracuse J, Kang J . Active smoking in claudicants undergoing lower extremity bypass predicts decreased graft patency and worse overall survival. J Vasc Surg. 2018; 68(3):796-806.e1. DOI: 10.1016/j.jvs.2017.12.044. View

12.

Altin S, Castro-Dominguez Y, Kennedy K, Orion K, Lanksy A, Abbott J . Predictors of Underutilization of Medical Therapy in Patients Undergoing Endovascular Revascularization for Peripheral Artery Disease. JACC Cardiovasc Interv. 2020; 13(24):2911-2918. DOI: 10.1016/j.jcin.2020.08.036. View

13.

Levin S, Hawkins S, Farber A, Goodney P, Osborne N, Tan T . Association of state tobacco control policies with active smoking at the time of intervention for intermittent claudication. J Vasc Surg. 2020; 73(5):1759-1768.e1. DOI: 10.1016/j.jvs.2020.08.156. View

14.

Williams C, Jellison A, Martin L, Zhang C, Presson A, Kraiss L . Optimal medical management before lower extremity bypass for claudication in the veteran population. J Vasc Surg. 2018; 69(2):545-554. DOI: 10.1016/j.jvs.2018.05.222. View

15.

Kalbaugh C, Gonzalez N, Luckett D, Fine J, Brothers T, Farber M . The impact of current smoking on outcomes after infrainguinal bypass for claudication. J Vasc Surg. 2018; 68(2):495-502.e1. DOI: 10.1016/j.jvs.2017.10.091. View

16.

Levin S, Farber A, Cheng T, Arinze N, Jones D, Rybin D . Patients undergoing interventions for claudication experience low perioperative morbidity but are at risk for worsening functional status and limb loss. J Vasc Surg. 2019; 72(1):241-249. DOI: 10.1016/j.jvs.2019.08.278. View

17.

Heidemann F, Kuchenbecker J, Peters F, Kotov A, Marschall U, LHoest H . A health insurance claims analysis on the effect of female sex on long-term outcomes after peripheral endovascular interventions for symptomatic peripheral arterial occlusive disease. J Vasc Surg. 2021; 74(3):780-787.e7. DOI: 10.1016/j.jvs.2021.01.066. View

18.

Aboyans V, Ricco J, Bartelink M, Bjorck M, Brodmann M, Cohnert T . 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Rev Esp Cardiol (Engl Ed). 2018; 71(2):111. DOI: 10.1016/j.rec.2017.12.014. View

19.

Siracuse J, Giles K, Pomposelli F, Hamdan A, Wyers M, Chaikof E . Results for primary bypass versus primary angioplasty/stent for intermittent claudication due to superficial femoral artery occlusive disease. J Vasc Surg. 2012; 55(4):1001-7. PMC: 3319263. DOI: 10.1016/j.jvs.2011.10.128. View

20.

Dansey K, Pothof A, Zettervall S, Swerdlow N, Liang P, Schneider J . Clinical impact of sex on carotid revascularization. J Vasc Surg. 2020; 71(5):1587-1594.e2. DOI: 10.1016/j.jvs.2019.07.088. View