Aortoiliac occlusive disease

The effects of gender on patient selection and results of intervention for aortoiliac atherosclerotic occlusive disease have received little attention in published reports. Review of our experience with aortobifemoral, femorofemoral, and axillofemoral bypass identified consistently more isolated anatomic aortoiliac disease in women, but virtually indistinguishable levels of preoperative ischemia as measured by clinical and hemodynamic indices. The performance of each of these three methods of reconstruction did not appear to be affected by gender. Review of other investigators' experience with these techniques as well as unilateral aortofemoral bypass, iliofemoral bypass, and PTBA did not find any evidence of discrepant performance of these latter techniques in women and men. This is in contrast to the results with infrainguinal reconstruction, which in our hands appear to be inferior in women. Concerns that results of aortoiliac reconstruction would be inferior in women due to small arteries or other differences appear unfounded. Women may be less likely to receive a recommendation for intervention for nonlimb-threatening ischemia due to gender biases on the part of the patient, primary physician, or vascular specialist, just as they are clearly less likely to be considered for intervention for coronary artery atherosclerosis. Our observations suggest that these biases are unfounded when formulating recommendations for women with aortoiliac atherosclerotic occlusive disease.