Gender-related differences in outcome: an analysis of 5880 infrainguinal arterial reconstructions

Few will debate that infrainguinal arterial reconstruction increases limb salvage. However, numerous reports describe a difference in results in coronary and peripheral arterial reconstructions between men and women. In this study, we analyze the outcome of infrainguinal bypasses performed over 30 years and stratify the results by gender.

We reviewed our vascular registry from 1968 to 1999 for all infrainguinal arterial reconstructions. Demographics, indications, and adverse outcomes were analyzed. Patency, limb salvage, and survival rates were determined with life-table analysis. The chi2, log-rank, and Student t tests were used to determine statistical significance.

Five thousand eight hundred eighty procedures were performed, with 2161 in women (37%). Women were significantly older (71 versus 66 years), more often diabetic (53% versus 50%), and less often smokers (27% versus 44%) and more often had surgery for limb salvage (89.8% versus 81.0%). Mortality, complications, and need for revision did not differ. Primary patency rate was 44% versus 47%, secondary patency rate was 55% versus 58%, and survival rate was 39% versus 34% in men and women, respectively, at 10 years (all P >.05). Limb salvage rate in women exceeded that in men (93% versus 88%) at 10 years. Subgroup analysis by conduit also revealed no difference in patency.

Infrainguinal arterial reconstruction can be performed safely with comparable results in women and men. Although women may present older and more often for limb salvage, outcomes do not appear to be adversely affected.