Sex-related differences in outcome after vascular interventions for lower limb ischemia

The purpose of this study was to investigate sex-related differences in outcome, defined as amputation rate and survival in patients treated for lower limb ischemia.

Age, sex, and type of procedure for all patients undergoing vascular interventions for lower limb ischemia in Stockholm, Sweden, from 1970 to 1994, were obtained from the National Board of Health and Welfare. All patients who underwent amputation after treatment were analyzed separately. Data on deceased patients were extracted from the cause-of-death register.

Women had lower survival rates than men at 30 days and 1 and 5 years after operation (89% vs 92%, 75% vs 80%, and 50% vs 55%; P <.001). In the multivariate analysis of risk factors for death during the whole study period, increasing age, calendar year (1980 to 1989), and male sex were significant risk factors (P <.001). The percentage of women who underwent amputation after treatment was comparable with the percentage of men who underwent amputation (11.4% vs 10.2%, P =.075). The multivariate analysis identified increased age and calendar year (1985 to 1994) as important risk factors for amputation (P <.001). Female sex was not found to increase the risk for amputation. Patients who underwent amputation were older than patients with intact limbs (73 vs 68 years, P <.001). The highest percentage of patients who underwent amputation was found among those treated with femorodistal bypass (20%, P =.001).

Female sex is not an important risk factor for poor outcome after treatment for lower limb ischemia, when their increased age has been accounted for. These results imply that we should continue to consider age and type of procedure when estimating outcome, and women should not be refused an intervention on a sex-related basis. We should possibly be more selective toward men considering their higher mortality rates.