Sex disparities in peripheral arterial occlusive disease
DOI:
https://doi.org/10.48750/acv.486Keywords:
Peripheral arterial occlusive disease, Sex disparities, Gender research, EpidemiologyAbstract
INTRODUCTION: Recently published studies on peripheral arterial occlusive disease (PAOD) have revealed marked sex disparities in patient selection and treatment outcomes. In a recent retrospective study with data from 11 different countries, Portugal was highlighted as one of the countries with greater sex discrepancies related to PAOD treatment. We aimed to analyze sex specific differences in the treatment of symptomatic PAOD, concerning different variables, in a single hospital center, in Portugal.
METHODS: Data on treatment of symptomatic PAOD patients from October 1st, 2020, to December 31st, 2021, were retrospectively collected from clinical registries from a single hospital center in Portugal. Different variables and post-operative outcomes were analyzed dichotomized by sex, with descriptive statistics. Statistical analyses were conducted using the IBM Statistical Package for Social Sciences (SPSS) software v28.
RESULTS: A total of 220 patients, 15,9% female and 84,1% male, were treated for PAOD, in the selected period, in a hospital center from Portugal. Female patients were older (mean age of 73.8 years versus 69.5 years in male); were less likely to be treated for intermittent claudication (3% versus 6% of men); more often treated at a more advanced stage of the disease with trophic lesions (91% versus 74% of men); more likely to be offered primary major amputation (14% versus 3% of male patients); less likely to be taking statins as part of PAOD medical management (65.7% versus 77.8% of male); and had a higher 90-day mortality rate (17.1% versus 6.5% in men). They were also more frequently treated with endovascular procedures (40%) than with OSR (26%).
CONCLUSION: Remarkable sex discrepancies in the treatment of PAOD were found in our hospital center. This study brings awareness to the scientific medical community for sex disparities in the management of patients with PAOD.
Downloads
References
Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet (London, England). 2013;382(9901):1329-40.
Unwin N. Epidemiology of lower extremity amputation in centres in Europe, North America and East Asia. The British journal of surgery. 2000;87(3):328-37.
Ramkumar N, Suckow BD, Brown JR, Sedrakyan A, MacKenzie T, Stone DH, et al. Role of Sex in Determining Treatment Type for Patients Undergoing Endovascular Lower Extremity Revascularization. Journal of the American Heart Association. 2019;8(17):e013088.
Schaumeier MJ, Hawkins AT, Hevelone ND, Sethi RKV, Nguyen LL. Association of Treatment for Critical Limb Ischemia with Gender and Hospital Volume. The American surgeon. 2018;84(6):1069-78.
Egorova N, Vouyouka AG, Quin J, Guillerme S, Moskowitz A, Marin M, et al. Analysis of gender-related differences in lower extremity peripheral arterial disease. Journal of vascular surgery. 2010;51(2):372-8.e1; discussion 8-9.
Rieß HC, Debus ES, Heidemann F, Stoberock K, Grundmann RT, Behrendt CA. Gender differences in endovascular treatment of infrainguinal peripheral artery disease. VASA Zeitschrift fur Gefasskrankheiten. 2017;46(4):296-303.
Hirsch AT, Allison MA, Gomes AS, Corriere MA, Duval S, Ershow AG, et al. A call to action: women and peripheral artery disease: a scientific statement from the American Heart Association. Circulation. 2012;125(11):1449-72.
Behrendt CA, Sigvant B, Kuchenbecker J, Grima MJ, Schermerhorn M, Thomson IA, et al. Editor's Choice - International Variations and Sex Disparities in the Treatment of Peripheral Arterial Occlusive Disease: A Report from VASCUNET and the International Consortium of Vascular Registries. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2020;60(6):873-80.
Peters F, Kreutzburg T, Rieß HC, Heidemann F, Marschall U, L'Hoest H, et al. Editor's Choice - Optimal Pharmacological Treatment of Symptomatic Peripheral Arterial Occlusive Disease and Evidence of Female Patient Disadvantage: An Analysis of Health Insurance Claims Data. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2020;60(3):421-9.
Kotov A, Heidemann F, Kuchenbecker J, Peters F, Marschall U, Acar L, et al. Sex Disparities in Long Term Outcomes After Open Surgery for Chronic Limb Threatening Ischaemia: A Propensity Score Matched Analysis of Health Insurance Claims. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2021;61(3):423-9.
Wang J, He Y, Shu C, Zhao J, Dubois L. The effect of gender on outcomes after lower extremity revascularization. Journal of vascular surgery. 2017;65(3):889-906.e4.
Ramkumar N, Suckow BD, Brown JR, Sedrakyan A, Cronenwett JL, Goodney PP. Sex-Based Assessment of Patient Presentation, Lesion Characteristics, and Treatment Modalities in Patients Undergoing Peripheral Vascular Intervention. Circulation Cardiovascular interventions. 2018;11(1):e005749.
Behrendt CA, Bischoff MS, Schwaneberg T, Hohnhold R, Diener H, Debus ES, et al. Population Based Analysis of Gender Disparities in 23,715 Percutaneous Endovascular Revascularisations in the Metropolitan Area of Hamburg. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2019;57(5):658-65.
Sigvant B, Kragsterman B, Falkenberg M, Hasvold P, Johansson S, Thuresson M, et al. Contemporary cardiovascular risk and secondary preventive drug treatment patterns in peripheral artery disease patients undergoing revascularization. Journal of vascular surgery. 2016;64(4):1009-17.e3.
Porras CP, Bots ML, Teraa M, van Doorn S, Vernooij RWM. Differences in Symptom Presentation in Women and Men with Confirmed Lower Limb Peripheral Artery Disease: A Systematic Review and Meta-Analysis. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2022;63(4):602-12.
Sigvant B, Hasvold P, Thuresson M, Jernberg T, Janzon M, Nordanstig J. Myocardial infarction and peripheral arterial disease: Treatment patterns and long-term outcome in men and women results from a Swedish nationwide study. European journal of preventive cardiology. 2021;28(13):1426-34.
Aboyans V, Ricco JB, Bartelink MEL, Björck M, Brodmann M, Cohnert T, et al. Editor's Choice - 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2018;55(3):305-68.
Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2017;69(11):e71-e126.
Miller SM, Sumpio BJ, Miller MS, Erben Y, Cordova AC, Sumpio BE. Higher Inpatient Mortality for Women after Intervention for Lifestyle Limiting Claudication. Annals of vascular surgery. 2019;58:54-62.
Lo RC, Bensley RP, Dahlberg SE, Matyal R, Hamdan AD, Wyers M, et al. Presentation, treatment, and outcome differences between men and women undergoing revascularization or amputation for lower extremity peripheral arterial disease. Journal of vascular surgery. 2014;59(2):409-18.e3.
