Sex-Based Differences in Periprocedural Complications Following Lower Extremity Peripheral Vascular Intervention

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Health Outcomes Research

Background:

• Sex-based outcome disparities are known in cardiovascular interventions, but less is understood for lower extremity peripheral vascular intervention (PVI).
• Symptomatic peripheral artery disease (PAD) affects numerous individuals, with PVI being a common treatment modality.

Purpose of the Study:

• To investigate if female sex is an independent predictor of periprocedural complications following lower extremity PVI.
• To compare outcomes between men and women undergoing PVI for PAD.

Main Methods:

• Analysis of a large cohort (119,620 patients) undergoing lower extremity PVI from the Vascular Quality Initiative registry (September 2016 - March 2020).
• Multivariate logistic regression models were employed to assess the independent association between female sex and post-PVI complications, adjusting for baseline characteristics.

Main Results:

• Women (39.6%) had significantly higher risks of access site complications, including hematoma (OR 1.45), pseudoaneurysm (OR 1.69), and access site occlusion (OR 1.89).
• Higher risks were observed for target lesion dissection (OR 1.36), above-knee amputation (OR 1.37), and in-hospital mortality (OR 1.21) in women compared to men.
• These elevated risks remained significant even after adjusting for patient and procedural variables.

Conclusions:

• Women undergoing lower extremity PVI for symptomatic PAD experience a higher risk of periprocedural complications than men.
• The increased risk of bleeding, amputation, and mortality in women persists independently of other factors.
• Further investigation is warranted to understand and mitigate these sex-based outcome differences in PVI.