Surgical treatment of infrainguinal arterial occlusive disease in women

Abstract

Purpose: This study reviewed the outcome of 131 women who underwent infrainguinal bypass in 150 limbs from 1984 to 1991 for limb-threatening ischemia (95%) or disabling claudication (5%).Methods: These women were compared with 209 men who underwent infrainguinal arterial reconstruction of 231 lower extremities for limb threat (89%) or claudication (11%) during the same interval. On average, women were 3 years older than men (mean age 72 vs 69 years, p < 0.005) but were less frequently cigarette smokers (56% women, 68% men, p < 0.05). Fifty-two percent of women had diabetes and 67% had hypertension, similar to the male patients. Infrainguinal disease distribution necessitated bypass to the above-knee popliteal artery in 10%, to the below-knee popliteal artery in 25%, and to the tibial or pedal arteries in 65% of women, comparable to the disease distribution in men. Autogenous vein grafts were performed in 90% of both groups.Results: Early postoperative (30-day) mortality was 4% for women and 2% for men (not significant). Life-table survival after 3 years, however, was only 54% in women, compared with 72% in men (p < 0.05). Multivariate analysis indicated that diabetes increased the mortality rate 2.5-fold in women, which was not true in men. Three-year life-table survival of women with diabetes was only 39%, compared with 78% in women without diabetes (p < 0.001). Primary graft patency in women was 59% at 1 year and 54% at 3 years, significantly less than the 73% and 70% graft patency rates observed in men (p < 0.005). Secondary graft patency improved in women to 75% and 69% after 1 and 3 years, but this was still significantly less than the secondary patency rates of 89% and 86% observed in men (p < 0.001). Multivariate analysis indicated that female sex decreased secondary graft patency 2.4-fold and was the only variable associated with graft failure. Cumulative 3-year limb salvage in women was 82%, not statistically different than the 89% limb salvage rate observed in men.Conclusions: Women and men requiring arterial reconstruction for infrainguinal occlusive disease had comparable operative mortality and limb salvage rates, but long-term survival and graft patency were significantly reduced in women. Our results indicate that sex substantially influences the outcome of patients after infrainguinal bypass.