Abstract 170: Worse Patency in Women After Endovascular Peripheral Vascular Intervention

Abstract

Objectives: Women are suspected to have worse outcomes after lower extremity revascularization. We sought to study how patency differed among men and women undergoing endovascular peripheral vascular intervention (PVI). Methods: We studied patients in the Vascular Quality Initiative who underwent a PVI (angioplasty, stent, or atherectomy) between January 2010 to October 2016. We excluded all reinterventions on a previously treated artery. The primary exposure was gender (men vs women) and our outcomes were reintervention or occlusion in each artery treated. We studied outcomes through 1-year post-procedure using Kaplan Meier survival analysis and Cox regression, stratified by artery treated. We adjusted for patient demographics and disease characteristics. Results: Our cohort included 106,073 eligible arteries treated in 58,247 patients across 66,045 procedures. Among these patients, the mean age was 68 years old, 15% were African-American, and 41% were women. Half (50%) of the arteries were treated with stents, 39% were treated with PTA alone, and 11% were treated with atherectomy. Follow-up data on patency was available in 64% of patients (n=37,442 patients, 67,292 arteries). Women experienced lower reintervention-free survival in the iliac (98.4% vs 98.8%, log rank p=0.01) and femoropopliteal (94.7% vs 95.6%, log rank p<0.001) vascular beds ( Figure ). After adjusted Cox regression, gender difference in the femoropopliteal arteries alone remained statistically significant, where women were 30% more likely to need reintervention to maintain artery patency than men (HR: 1.31, 95% CI: 1.18-1.44). Similarly, women experienced lower occlusion-free survival in iliac (95.0% vs 95.9%, log rank p<0.001) and femoropopliteal (88.5% vs 90.9%, log rank p<0.001) arteries. Again, after adjustment, the gender difference remained statistically significant only in the femoropopliteal arteries, where women were 33% more likely than men to have an artery occlude after intervention (HR: 1.33, 95% CI: 1.16-1.53). Conclusions: Women undergoing PVI in the femoropopliteal arteries are more likely to develop an occlusion or need a reintervention in the treated artery within 1-year after intervention. We need further research and improved follow-up data on patency to understand how and why these sex differences arise.