CLTIに対する血管内血行再建術の性差と転帰

The mainstay of treatment for chronic limb-threatening ischemia (CLTI), late-stage peripheral arterial disease (PAD), is prompt revascularization. However, contemporary data on sex differences in CLTI-related endovascular revascularization rates and outcomes remain limited.

This is a retrospective cohort study. Using a 100% sample of Medicare Fee-for-service claims from 2016-2023, we identified patients undergoing lower-extremity endovascular revascularizations. Male and female sex was the exposure. Population rates of CLTI-related endovascular revascularization were calculated by sex. Baseline characteristics were compared using standardized mean differences. The primary outcome, a composite of major amputation and death, was analyzed using Kaplan-Meier methods and multivariable Cox regression adjusted for demographics, comorbidities, revascularization modality, disease severity, and other mediators. Non-death outcomes included major amputation, minor amputation, repeat revascularization, and worsening of ambulatory status.

Among 333,173 patients undergoing revascularization for CLTI from 2016-2023, 146,644 (44.0%) were female. Females were older (75.7 vs. 73.3 years) and more likely to be Black and from socioeconomically distressed communities. Compared with males, female patients had a lower adjusted risk of mortality or major amputation (HR 0.91, 95% CI 0.90-0.92, p<0.0001), major amputation (HR 0.82, 95% CI 0.81-0.84, p<0.0001), and mortality (HR 0.93, 95% CI 0.92-0.94, p<0.0001). However, female patients were more likely to experience restriction in ambulatory function post-revascularization (HR 1.06, 95% CI 1.05-1.08, p<0.0001).

Females underwent CLTI revascularization at lower rates than males, and experienced lower risks of mortality and major amputation, with higher rates of ambulatory decline. Continued investigation into modifiable drivers of sex differences can improve the quality of vascular care for both men and women with PAD.