Sex Differences in Peripheral Arterial Disease: Presentation, Treatment, and Outcomes

To summarize current evidence on sex-related differences in peripheral arterial disease (PAD) with respect to risk factors, disease distribution, response to endovascular therapy, and surgical outcomes. This review synthesizes data from observational studies, registries, and randomized trials evaluating sex-based differences in PAD epidemiology, anatomy, treatment patterns, and clinical outcomes. Women with PAD typically present at an older age and have a higher prevalence of comorbidities, including diabetes, chronic kidney disease, anemia, and frailty. They are less likely to receive guideline-directed medical therapy and more frequently present with atypical symptoms, contributing to delayed diagnosis and higher rates of chronic limb-threatening ischemia. Anatomically, women exhibit smaller vessel diameters, more diffuse and distal disease, and greater lesion complexity. Endovascular therapy yields similar or lower rates of major amputation in women compared with men; however, women experience higher rates of repeat revascularization and periprocedural complications, likely related to vessel size and comorbidity burden. In surgical revascularization, historical disparities in outcomes have diminished, with contemporary data demonstrating comparable limb salvage rates, although women may still experience longer hospital stays and higher wound complication rates. Sex differences in PAD significantly impact clinical presentation, anatomical patterns, and treatment outcomes. Women present later with more advanced disease yet achieve similar or improved limb salvage compared with men. These findings underscore the need for earlier diagnosis, equitable medical therapy, and individualized treatment strategies. Future studies should incorporate sex-specific analyses to optimize PAD management and improve outcomes across populations.