The Impact of Patient Sex on Outcomes after Endovascular Treatment of Aortoiliac Occlusive Disease

Abstract

The aim of this study was to explore the effect of patient sex on short and long-term outcomes after endovascular treatment for aortoiliac occlusive disease (AIOD). A multi-center retrospective analysis was performed on all patients who underwent iliac artery stenting for aorto-iliac occlusive disease across the three participating sites from October 1, 2018 to September 21, 2021. Preoperative clinical, operative, and post-operative data were collected on a dedicated database. Demographics and outcomes were compared between male and female patients and the probability of freedom from amputation and freedom from target lesion reintervention were estimated with the Kaplan-Meier method. Of 574 patients, 346 (60%) were male and 228 (40%) were female. Mean follow-up was 12 months. Female patients were significantly older (69.2 ± 10.2 years vs. 67.8 ± 8.9 years, p=0.025) and more likely to have Trans-Atlantic Inter-Society Consensus (TASC II) D disease (p=0.003). The female cohort had significantly less coronary artery disease (40% vs. 50%, p=0.013), coronary stenting (14% vs. 21%, p=0.039), and coronary artery bypass grafting (13% vs. 25%, p < 0.001) than the male cohort, as well as less statin use (69% vs 80%, p=0.004). There were no differences in stent type, concomitant open surgery, intraoperative events or hospital length of stay. For 30-day post-operative complications, female patients had a significantly higher rate of thrombotic acute limb ischemia (2% vs. 0%, p=0.01), while male patients had a higher rate of amputation (4% vs. 9%, p=0.048). On mid-term outcomes, there was no difference in freedom from amputation or target lesion re-intervention between male and female patients (p=0.14, p=0.32 respectively). Female patients had lower incidence of cardiovascular risk factors but presented with higher TASC II classification and had higher rates of 30-day thrombotic acute limb ischemia. Male patients were more likely to require amputation within 30 days. Despite no differences in the mid-term, these short-term findings suggest that patient sex may be a relevant consideration in post-operative management and surveillance after endovascular treatment of AIOD.