Association between gender and outcomes of lower extremity peripheral vascular interventions

The purpose of this study was to evaluate the association of gender with outcomes of peripheral vascular intervention (PVI) for intermittent claudication and critical limb ischemia (CLI).

We reviewed 3338 patients (1316 [39%] women) undergoing PVI for claudication (1892; 57%) or CLI (1446; 43%) in the Vascular Study Group of New England from January 2010 to June 2012. Kaplan-Meier analysis, stratified by indication, was used to assess relationships between gender and the main outcome measures of major amputation, reintervention, and survival during the first year.

Indications for PVI included claudication (n = 719 [38%] vs n = 1173 [62%]) and CLI (n = 597 [41%] vs n = 849 [59%]) in women and men, respectively (P = .0028). Women were older (69 vs 66 mean years; P < .00001), with less diabetes (43% vs 49%; P = .01), renal insufficiency (4.6% vs 7.3%; P = .0029), coronary artery disease (28% vs 35%; P < .00001), smoking (76% vs 86%; P = .01), and statin use (60% vs 64%; P = .0058). Technical success (95% vs 94%; P = .11), vascular injury (1.3% vs 1.0%; P = .82), and distal embolization (1.6% vs 1.3%; P = .46) were similar. Higher rates of hematoma (7.1% vs 3.4%; P ≤ .0001) and access site occlusion (0.91% vs 0.24%; P = .0085) were observed in women compared with men. There were no differences in major amputation (0.6% vs 0.6%; P = .81) or mortality (2.1% vs 1.5%; P = .20) rates at 30 days between women and men. Reinterventions (surgical and percutaneous) were similar between genders for claudicants (log-rank test, P = .75) and CLI patients (log-rank test, P = .93). Major amputation rates during the first year were not different for women and men and with claudication (log-rank test, P < .55) or CLI (log-rank test, P < .23). One-year survival was not different between women and men with claudication (95% vs 96%; P = .19) or CLI (77% vs 79%; P = .35).

Whereas we observed higher rates of access site complications including hematoma and occlusion in women, we found no other evidence for gender disparity in reinterventions, major amputation, or survival rates after PVI for patients with claudication or CLI.