Sex-related disparities in lower-extremity revascularization outcomes brought into focus

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Keyuree K. Satam

Women are more likely to undergo reintervention after lower extremity revascularization for peripheral arterial disease (PAD) compared to male patients with similar limb salvage and survival outcomes despite having fewer comorbidities, findings of a retrospective analysis presented during the William J. von Liebig Forum at VAM 2023.

Keyuree K. Satam, MD, an incoming vascular surgery intern at Stanford Hospital presented the findings of the analysis, outlining that prior research has suggested that women are more likely to undergo these repeat procedures than men.

The current study analysed patients who had a revascularization procedure for PAD between 2013 and 2020 at a tertiary care center, looking at comorbidities, perioperative, and long-term outcomes by sex, as well as the rate and frequency of reintervention. The study team carried out Kaplan-Meier analyses for major adverse limb event (MALE)-free survival.

The study included 1,987 patients undergoing lower extremity revascularization, of whom 37% (n=736) were female. The female patients included were more likely to be older (70.5 years vs. 69.2, p=0.015) and Black (18% vs. 12.3%, p=0.003). Male participants were more likely to have a higher prevalence of comorbidities including coronary artery disease (59.3% vs. 45.6%, p<0.0001), diabetes (60.2% vs. 51.9%, p=0.0003), and chronic renal insufficiency (20.1% vs. 15.8%, p=0.016).

The speaker shared that patients in the study had a total of 2,647 reinterventions, with females having a significantly higher rate of ipsilateral reinterventions compared to males (2.0±1.5 vs. 1.7±1.4, p=0.05) and a higher proportion of ≥3 reinterventions (9.5% vs. 6.6%, p=0.035). Kaplan-Meier curves showed no difference between males and females regarding MALE-free survival.

Satam noted that perioperative complications were similar for male and female patients, except for those resulting in a return to the operating room, which was higher among males (17.7% vs. 13.9%, p=0.029). After a mean follow-up of three years, there was no difference in major amputation, reintervention rate, MALE, or mortality.

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