Sex-Based Differences in Arterial Anatomy Do Not Affect Primary Patency after Endovascular Intervention for Chronic...

Sex-based differences in patency outcomes attributed to artery size have been observed in peripheral artery disease studies. However, variation in the superior mesenteric artery (SMA) dimensions between genders in the chronic mesenteric ischemia (CMI) population is not well documented. This study aimed to compare the anatomical characteristics of SMA and assess patency outcomes between sexes in patients with CMI.

A retrospective review of all patients who underwent SMA stenting for CMI at a single quaternary center from 2003 to 2020 was conducted. The cohort was stratified according to self-identified gender. Anatomical SMA measurements, such as native diameter (ND) and length of the atherosclerotic lesion (LL), and procedural SMA measurements, such as proximal flare diameter (FD) and FD-to-ND ratio, were reviewed. FD was defined as the maximal postdilatation stent diameter at the SMA orifice. Multivariable Cox proportional hazard models were also conducted to evaluate anatomic predictors for primary patency loss.

A total of 182 patients were included. The overall mean age was 71 years, and 69.8% were women. No significant difference in comorbidities was found between female and male patients. Technical success was achieved in all cases, and 94% had complete resolution of presenting symptoms with no discrepancy between sexes. SMA measurements demonstrated a significantly smaller ND in the female compared to the male cohort (5.2 mm vs. 6.9 mm; P < 0.001). FD was smaller in the female compared to the male cohort (10.4 mm vs. 13.5 mm; P < 0.001). No difference was found in the LL or FD-to-ND ratio between cohorts. In multivariable analyses, greater FD (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.89, 1.07; P = 0.59) and larger ND (HR 0.88, 95% CI 0.71, 1.08; P = 0.22) trended toward lower primary patency loss without statistical significance. LL and FD-to-ND ratio were not independently associated with patency outcomes. Male sex was associated with an increased risk of primary patency loss (HR 3.07, 95% CI 1.18, 7.96; P = 0.024). Brachial access-related complications were more commonly seen in the female cohort (17.1%, 6.4%, P = 0.075).

In a large population treated for CMI, we observed a statistically significantly smaller SMA diameter in the female cohort. No difference in primary patency loss was observed with vessel diameter. Male sex was associated with an increased risk of primary patency loss. This finding suggests that technical considerations, such as complete lesion coverage, may offset the impact of vessel diameter.