The Influence of Gender on the Outcomes of Revascularization for Aortoiliac Occlusive Disease

The objective of the present study was to assess the impact of gender on outcomes following endovascular treatment of AIOD, focusing on patency, limb salvage, reintervention rates, and survival.

This retrospective cohort study of prospectively collected data included consecutive patients with AIOD who underwent aortoiliac angioplasty between January 2017 and January 2024. Two groups were analyzed: (1) female patients, (2) male patients. Eligible patients presented with critical limb-threatening ischemia or disabling claudication. Regression cox was performed to evaluate the factors related to primary patency, major amputation, and overall survival. Among several factors analyzed, covered versus bare-metal stents and common femoral endarterectomy were evaluated.

A total of 108 endovascular procedures were attempted. Technical success was achieved in 103 patients (95.4%), who comprised the study cohort. The female group predominated with 57 patients (55.3%) and the male group with 46 patients (44.7%). Arterial hypertension was the most prevalent comorbidity (79.6%), with higher prevalence at female group than male group (87.7% vs. 69.6%, P = 0.021), followed by dyslipidemia (63.1%), diabetes mellitus (54.4%), and ischemic heart disease (28.2%), with higher prevalence at male group than female group (65.3% vs. 34.5%, P = 0.005). Concomitant common femoral endarterectomy (CFE) was performed in 11 patients (10.7%; 13% male group and 8.8% female group; P = 0.48). The perioperative mortality rate was 11.7%, with no significant differences among groups (P = 0.82). Primary patency at 1,000 days was 80.1% at male group and 78.1% at female group (P = 0.43). Limb salvage rates at 1000 days were 95.5% at male group and 95.5% at female group, P = 0.57. Cox regression analysis identified bare-metal stent use as a predictor of reduced primary patency (HR 15.99, 95% CI 2.07-122.996; P = 0.008). Conversely, CFE was a protective factor for better primary patency (HR 0.123, 95% CI 0.020-0.778; P = 0.026).

In conclusion, female and male patients with AIOD submitted to endovascular treatment had similar outcomes regarding patency, limb salvage rates, overall survival, and freedom from target-lesion reintervention. Moreover, covered stent use was associated with higher primary patency and lower reintervention rates compared with bare-metal stents, and concomitant CFE was a protective factor for better primary patency.