Female Patients Have More Reinterventions after Lower Extremity Revascularization for Peripheral Arterial Disease

Reinterventions after lower extremity revascularization (LER) for peripheral arterial disease (PAD) are common. Previous studies observed increased reintervention rates in females; however, the frequency of reinterventions between males and females has not been compared. This study highlights sex differences in outcomes of LER focusing on reintervention patterns.

A retrospective analysis of patients undergoing LER for PAD between 2013 and 2020 at a tertiary care center was conducted. Perioperative and long-term outcomes were compared, as well as reinterventions after initial LER between males and females.

A total of 1,987 patients underwent LER, of whom 736 (37%) were female. Females were older (70.5 vs. 69.2, P = 0.015) and more likely to be Black (18% vs. 12.3%, P = 0.003). Males were more likely to have coronary artery disease (59.3% vs. 45.6%, P < 0.0001), diabetes (60.2% vs. 51.9%, P = 0.0003), and renal insufficiency (20.1% vs. 15.8%, P = 0.016). Perioperative complications were similar except return to operating room, which was higher in males (17.7% vs. 13.9%, P = 0.029). After mean follow-up of 3.1 years, there was no difference in major amputation or mortality. Kaplan-Meier survival curves showed no difference in freedom from MALE and MALE-free survival. Females were more likely to have 2 or more ipsilateral reinterventions (P = 0.030) and higher mean ipsilateral reinterventions (2.0 ± 1.5 vs. 1.7 ± 1.4, P = 0.050).

Despite fewer comorbidities, females underwent higher frequency of reinterventions with no difference in major amputation or mortality. Effectiveness of reinterventions in females versus males warrants further investigation.