Gender Differences Before and After Lower Limb Revascularisation

Abstract

Objective: Sex specific data on outcomes after lower limb revascularisation have associated female gender with worse surgical outcomes, particularly after open procedures. Women were found to be more likely to suffer from procedure complications, limb loss, and death than their male counterparts. Methods: This retrospective, observational study included all first lower limb revascularisation procedures performed in a tertiary hospital, between January 2017 and December 2018, in patients with diagnosed PAD. Women’s limbs, Group (F), were compared with men’s limbs, Group (M). The primary endpoint was major amputation and secondary endpoints were restenosis/occlusion, vascular re-intervention, and overall survival. Subgroup analysis was undertaken considering open, endovascular, or hybrid procedures. Results: Group M included 324 lower limbs; patients had a mean age of 67.5 years. Group F included 96 lower limbs; patients had a mean age of 71.7 years (p < .001). There were no significant differences in cardiovascular risk factors between groups, aside from a higher prevalence of smoking in Group M and hypertension in Group F (p < .001). Of the procedures, 83% in Group F and 79% in Group M were performed to treat CLTI (p = .321). No statistically significant difference was found between groups regarding wound or infection grading (WIfI) and aorto-iliac, femoropopliteal or BTK anatomic disease staging (GLASS). Group M was morelikely to have common femoral artery disease (p < .001) and Group F to have more severe BTK disease (p = .017). Group F had a higher proportion of endovascular procedures (p < .001). Amputation rates in Group M and Group F were 8 ± 2% and 7 ± 3% at one month, 14 ± 2% and 16 ± 4% at one year, and 15 ± 2% and 19 ± 4% at two years, respectively (Fig. 1; p = .564). There were no significant differences in restenosis/occlusion rates between groups (p = .395). Re-intervention rates in Group M and Group F were 13 ± 2% and 13 ± 3% at one month, 21 ± 2% and 20 ± 4% at one year, and 25 ± 3% and 24 ± 5% at two years, respectively (Fig. 2; p = .74). Overall survival in Group M and Group F was 97 ± 1% and 93 ± 3% at one month, 84 ± 2% and 84 ± 4% at one year, and 77 ± 3% and 72 ± 5% at two years, respectively (p = .443). Stratifying according to the type of vascular procedure (open, endovascular, or hybrid), no significant difference was found between groups for the above mentioned outcomes (amputation, restenosis/occlusion and re-intervention rates, overall survival). Conclusion: Overall, this study suggests no major difference in limb outcomes for women who undergo lower limb revascularisation procedures. Women were more likely to be older, to have more severe BTK disease, and to undergo endovascular procedures. This absence of difference in outcomes may be explained by the high proportion of endovascular revascularisation procedures for CLTI in this study population. According to this study, there is no reason to expect worse limb outcomes in women. Keywords: Chronic limb threatening ischaemia (CLTI), Gender, Lower limb revascularisation, Peripheral arterial disease (PAD)Figure 2Kaplan–Meier estimates of diagnosed vascular procedure restenosis/occlusion rates.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Kaplan–Meier estimates of vascular re-intervention rates.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 4Kaplan–Meier estimates of overall survival.View Large Image Figure ViewerDownload Hi-res image Download (PPT)