Sex-Based Assessment of Patient Presentation, Lesion Characteristics, and Treatment Modalities in Patients Undergoing Peripheral Vascular Intervention

Abstract

Background: Limited evidence suggests that women and men might be treated differently for peripheral arterial disease. This analysis evaluated sex-based differences in disease presentation and its effect on treatment modality among patients who underwent endovascular treatment for peripheral arterial disease.

Methods and results: Using national registry data from the Vascular Quality Initiative between 2010 and 2013, we examined patient, limb, and artery characteristics by sex through descriptive statistics. We studied 26 750 procedures performed in 23 820 patients to treat 30 545 limbs and 44 804 arteries. Women presented at an older age (69 versus 67 years; P<0.001) and were less often current or former smokers (72% versus 85%; P<0.001). Transatlantic Inter-Society Consensus classification was similar among men and women (Transatlantic Inter-Society Consensus C or D: 37% in men versus 37% in women; P=0.81), as was mean occlusion length (4.5 cm in men versus 4.6 cm in women; P=0.04), even after accounting for lesion location. Women more frequently underwent treatment for rest pain (11% in men versus 16% in women; P<0.001) versus claudication (59% in men versus 53% in women; P<0.001) or tissue loss (28% in men versus 27% in women; P=0.75). Treatment modality did not differ by sex but was associated with disease severity (P for trend <0.001) and lesion location (P for trend <0.001).

Conclusions: Women undergo peripheral endovascular intervention for peripheral arterial disease at an older age with critical limb ischemia. Treatment modalities do not vary by sex but are determined by disease severity and site. Although there exist sex differences in presentation, these differences do not lead to differential treatment for women with peripheral arterial disease.

Keywords: endovascular procedures; female; male; peripheral artery disease; sex characteristics.

Figure 1:

Creating the Cohort. This flowchart depicts the inclusion and exclusion criteria applied to each procedure in the registry to form the analytic cohort. This cohort was analyzed in three approaches, as outlined above: by patient, by limb, and by artery treated. For illustrative purposes, this diagram includes the number of eligible aorta only treatments (n=123), however these procedures were not included in any analyses.

Figure 2:

Number of arteries treated per limb by sex and indication in (A) unilaterally and (B) bilaterally treated limbs. This figure shows the effect of disease severity on the proportion of unilaterally and bilaterally treated limbs with multilevel disease in men and women.

Figure 3:

(A) Overall and (B) within-artery distribution of arteries treated by sex. This figure shows the distribution of arteries treated in men and women, as well as the proportion of men versus women for each artery type treated.

Figure 4.

Treatment delivered by artery treated, sex, and indication (A) claudication, (B) rest pain and (C) tissue loss. This figure shows the distribution of treatment modalities delivered to each artery treated by artery type and indication for men and women.