Percutaneous intervention for infrageniculate arterial disease in women may be associated with better outcomes when compared to men

Abstract

Objective: The purpose of this study was to identify any gender-associated differences in the percutaneous treatment of infrageniculate lesions in individuals with chronic critical limb ischemia.

Methods: A retrospective chart review was performed on 112 index tibial lesions in 81 consecutive patients operated on from January 2005 to February 2011. All patients were treated for critical limb ischemia-defined as rest pain or tissue loss. Patient demographics, comorbidities, clinical presentation, vascular studies, lesion characteristics, procedures, and postoperative complications were entered into a database for review. Patients were evaluated for primary patency, secondary patency, limb salvage, and mortality rates.

Results: Sixty-three index tibial lesions were treated percutaneously in 43 women, compared to 49 lesions in 38 men. There was a trend toward increased cardiac disease (65.8% men vs 44.2% women; P = .052) and smoking (52.6% men vs 32.6% women; P = .070) in men. Men were more likely than women to have TransAtlantic Inter-Society Consensus (TASC) C and D lesions (83.7% vs 65.1%; P = .023) and to be treated for total occlusion (44.9% vs 25.4%; P = .031). There were no significant gender-related differences in length of stay or postoperative complications. Women had statistically better primary patency rates than men at 12 and 24 months (77.5% ± 6.9% and 72.9% ± 7.8% in women vs 58.7% ± 9.3% and 45.2% ± 9.9% in men; P = .032). Women also had statistically better secondary patency rates than men at 12 and 24 months (90.4% ± 4.8% and 85.1% ± 6.8% in women vs 76.0% ± 8.1% and 58.5% ± 10.8% in men; P = .028). Female gender remained an independent predictor of superior patency even after controlling for gender-related differences in TASC grade. There were no significant differences in limb salvage rates at 12 and 24 months (92.1% ± 4.4% and 85.0% ± 7.9% in women vs 88.3% ± 6.4% and 83.4% ± 7.7% in men; P = .985). Overall survival rates were similar (59.8% ± 7.6% for women and 68.0% ± 8.1% for men at 24 months; P = .351).

Conclusions: Percutaneous intervention may be an equally effective or better treatment option for women with chronic limb ischemia and tibial disease when compared to men. In this study, male gender was an independent predictor of poorer primary and secondary patency rates after infrageniculate intervention. There were no differences in postoperative wound complications between genders. Endovascular procedures may lessen the gap in gender-related treatment outcomes and postoperative complications seen after open arterial reconstructions.