A new U.S. study has found that female sex is associated with more reinterventions after surgical treatment for intermittent claudication. Additionally, guideline-directed medical therapy, including aspirin and statin use, was used less frequently among female compared with male patients in both the preoperative and postoperative settings.
“Based on these findings, we recommend that vascular interventionists treating female patients with intermittent claudication increase their efforts to maximize medical therapy and discuss with their patients the differences in intervention durability based on patient sex,” explained first author Scott R. Levin, MD, from Boston University School of Medicine and Boston Medical Center, Boston.
The researchers conducted a retrospective analysis of patients undergoing vascular interventions for intermittent claudication in more than 800 academic and non-academic centers in North America from 2010–20. Among the 64,752 peripheral vascular interventions, 38% were performed in female patients. Out of the 9,314 infrainguinal bypasses and 3,227 suprainguinal bypasses, 30% and 37% were performed in female patients, respectively. Female compared with male sex was associated with increased reinterventions after peripheral vascular interventions, infrainguinal bypasses and suprainguinal bypasses at one year.
Additionally, they found that regardless of patient sex, one-year amputation rates were higher than expected compared to medical management (smoking cessation, aspirin and statin therapy, a walking program) alone prompting Levin to recommend that surgeons attempt an adequate period of medical therapy prior to offering invasive interventions for intermittent claudication.
According to the researchers, increasing medical options, particularly for an elective vascular procedure, is essential and an area for immediate improvement. “However, this is only one factor that may mitigate the disparity in reintervention rates by patient sex. Future prospective analysis is warranted to assess the reasons for the type of intervention offered, as well as for suboptimal medical therapy, treatment failures, and need for reintervention among female patients,” said Levin.
These findings appear online in the journal Annals of Vascular Surgery.