The Impact of Vessel Size and Sex on Outcomes after Infrainguinal Revascularization for Lower Extremity Peripheral...

The impact of vessel size on outcomes associated with peripheral artery disease (PAD) is not well studied. In addition, the data regarding sex-specific outcomes after intervention for PAD is lacking. We sought to do a preliminary investigation into the relationship between sex and surgical outcomes as well as between vessel size and surgical outcomes after both endovascular and open surgical revascularization for PAD.

We conducted a 2010-2022 single-center retrospective review of 390 consecutive patients with PAD, including 172 females (44%) and 218 males (56%). We reviewed computed tomography angiography imaging and measured the common femoral artery (CFA) area to determine vessel size. Reference values of average CFA area (52.8-75.4 mm²) were used to define size for normal (n = 160), small (<52.8 mm², n = 130), and large vessels (>75.4 mm², n = 100). Outcomes evaluated included 30-day major adverse limb event (MALE)-free survival and major adverse cardiovascular event (MACE)-free survival as well as 5-year patency, amputation-free survival, and overall survival.

Mean CFA area was 50.6 mm² in females and 64.5 mm² in males (P < 0.01). On univariable analysis, large vessels were associated with lower rates of amputation-free survival (P = 0.03). In addition, females had significantly lower rates of overall survival (P = 0.03). On multivariable analysis, neither vessel size nor patient sex was associated with differences in MACE-free survival, MALE-free survival, patency, amputation-free survival, or overall survival.

Vessel size was not demonstrated to have a significant impact on outcomes related to lower extremity revascularization in patients with PAD. Because target vessel size is often a technical consideration in PAD interventions, further investigation is needed to develop guidelines to optimize therapy based on vessel size.