The Impact of Sex on Atherectomy Outcomes for Different Anatomic Regions

There is a paucity of research that examines the influence of sex on outcomes after atherectomy for peripheral artery disease. This study examines the impact of sex on atherectomy outcomes, specifically for different anatomic regions.

Data from the Vascular Quality Initiative (2010-2022) were analyzed and atherectomy location was categorized into the following anatomic segments: femoral, popliteal, and tibial. Multivariate logistic regression calculated the odds ratio (OR) for various 1-year major amputation and 1-year reintervention, controlling for demographics, clinical presentation, and comorbidities. Cox proportional hazards analysis calculated the hazard ratio (HR) for major amputation and reintervention, controlling for the same covariates.

Of the 51,174 combined infra-inguinal atherectomy patients, 20,132 (39.3%) were female. Overall, female patients were less likely to experience amputation (HR = 0.77, confidence interval [CI] = 0.69-0.86, P < 0.001), with this trend persisting for the femoral arteries (HR = 0.65, CI = [0.51-0.82], P < 0.001) and the popliteal arteries (HR = 0.40, CI = [0.21-0.78], P = 0.007). Female sex was associated with a higher OR for 1-year reintervention in the overall (OR = 1.18, CI = [1.06-1.31], P = 0.002), femoral arteries (OR = 1.27, CI = [1.05-1.52], P = 0.012), and popliteal artery group (OR = 2.28, CI = [1.33-3.97], P = 0.003). Similarly, female sex was associated with a higher HR for reintervention in the overall (HR = 1.20, CI = [1.10-1.30], P < 0.001), femoral arteries (HR = 1.27, CI = [1.10-1.47], P < 0.001), and popliteal artery group (HR = 2.28, CI = [1.47-3.53], P < 0.001). No sex-related differences in time-to-amputation (HR = 0.71, CI = [0.50-1.00], P = 0.053), 1-year reintervention (OR = 0.74, CI = [0.42-1.26], P = 0.3), or time-to-reintervention (HR = 0.84, CI = [0.54-1.31], P = 0.5) were observed for tibial lesions.

Female sex was associated with a protective effect against major amputation after atherectomy for lesions above the knee despite being associated with increased risk of reintervention in atherectomy lesions above the knee, specifically the femoral arteries and popliteal artery. However, these disparities were absent for atherectomy lesions below the knee-female sex was not associated with increased or decreased risk of amputation or reintervention in tibial atherectomies. Further studies focused on specific demographics, risk factors, and comorbidities may help us choose the best endovascular approach for different clinical scenarios of peripheral artery disease.