Stent Diameter, Not Sex, Is Predictive of Reintervention after Common Iliac Artery Stenting

Female sex is associated with adverse limb events following revascularization for peripheral artery disease (PAD). Specifically, poorer patency, with more reinterventions following iliac artery stenting. We hypothesize stent diameter will be associated with an increased risk of reintervention among all patients regardless of sex group.

We included adults undergoing unilateral, elective, index, common iliac stenting only for PAD (Vascular Quality Initiative peripheral vascular interventions database; 2015-2022) excluding those with aneurysms and lacking follow-up. Stents <8 mm were defined as small. Kaplan-Meier and multivariable Cox regression compared 1-year reintervention. Interaction terms evaluated subgroups.

We identified 4,844 patients including 1,935 (40.0%) females. Females were older (67.8 ± 10.7 vs. 67.1 ± 9.7) with fewer comorbidities and were less frequently prescribed perioperative aspirin (72.9% vs. 76.2%) or statins (75.8% vs. 79.6%, all P < 0.05). Most stents were for claudication (64.4%), yet females had more critical limb threatening ischemia (39.5% vs. 32.7%; P < 0.001). Although females received smaller stents (38.0% vs. 17.8%, P < 0.001), sex was not associated with reintervention. Smaller stents were associated with increased reintervention (P < 0.001). The association between small stents and increased reinterventions did not differ between sexes (p-interaction>0.05).

Small stent diameter, not female sex, was associated with an increased risk of reintervention following iliac stents for PAD. However, females were less frequently medically optimized and received smaller stents, possibly contributing to long-term stent failure described previously.