Increased Reintervention After Infrainguinal Revascularization for Chronic Limb-Threatening Ischemia in Women

Abstract

The objective of this study was to determine if there are gender-based differences in major adverse limb events after revascularization for chronic limb-threatening ischemia (CLTI) and to identify potential associated factors. This was a single-center retrospective analysis of 151 patients who underwent infrainguinal revascularization for CLTI between April 2013 and December 2015. Only the first revascularized limb was included in patients with bilateral CLTI. Demographic data and clinical outcomes were collected using electronic medical records. The mean age was 68.1±12.1years, and 55 of 151 (36%) were women. Women were less likely to carry a diagnosis of hyperlipidemia (60% vs. 83%; P=0.003), less likely to be on a statin medication (58% vs. 81%; P=0.004), and less likely to undergo an infrapopliteal revascularization (60% vs. 77%; P=0.04) compared with men. There were no differences between genders with regard to the Society for Vascular Surgery Wound Ischemia and Foot Infection stage at presentation or utilization of open versus endovascular intervention. During the median follow-up time of 678days (interquartile range, 167-1277days), 48 of 151 patients (32%) underwent reintervention on the threatened limb and 23 of 151 patients (15%) underwent major amputation. Women were more likely than men to need reintervention (P=0.02). There was no difference between genders for major amputation (P=0.48) or overall survival (P=0.65). In a multivariable Cox proportional hazards model for reintervention that included gender, preoperative body mass index, hyperlipidemia, preoperative anticoagulation, and ischemia score ≥2 (all P<0.20 in univariate analysis), female gender (hazard ratio [HR], 1.96 [1.10-3.54]; P=0.02) and hyperlipidemia (HR, 2.32 [1.07-5.03]; P=0.03) were significantly associated with increased rates of reintervention. Women undergoing lower extremity revascularization for CLTI were more likely to require reintervention compared with men but had similar rates of limb preservation. Further study is required to understand potential causative factors to improve treatment outcomes in women.