Worldwide prevalence of peripheral artery disease (PAD) is increasing and endovascular revascularisation (ER) has become the primary invasive treatment option. This study aims to illuminate gender disparities in ER of PAD.
This is a retrospective, cross-sectional study design. All inpatient invasive, percutaneous endovascular treatments of PAD conducted in the metropolitan area of Hamburg (Germany) were consecutively collected between 01/2004-12/2015. Relevant sociodemographic risk factors, technical assessments, procedural details, and in-hospital outcomes were collected and subsequently analysed.
A total of 23,715 ERs were identified (39.7% females). Female patients were older (74 versus 70 years, p<0.001) and suffered more often from rest pain (12.0% versus 9.7%, p<0.001) at the time of presentation. No differences were found for index lesion complexity (Trans-Atlantic Inter-Society Consensus classes) and the ankle-brachial-index was less often stated to be not valid in females (5.9% versus 7.1%, p=0.005 for intermittent claudication; 28.5% versus 32.0%, p=0.001 for chronic limb-threatening ischaemia, CLTI). If the ER was performed for CLTI, crural vessels below the knee were less often revascularized in females (32.2% versus 42.7%, p<0.001). Perioperative major bleeding complications including pseudoaneurysms occurred two-times more often in females and female gender was an independent predictor of bleeding complications in the adjusted analyses (odds ratio 2.32, 95% CI 1.49 to 3.64, p<0.001 for IC; odds ratio 1.67, 95% CI 1.10 to 2.53, p=0.017 for CLTI). Lastly, females were more often transferred to nursing homes when compared to males (0.3% versus 0%, p=0.001 for IC; 2.5% versus 1.2%, p<0.001 for CLTI).
In this study considering percutaneous ER for PAD, female patients were older, have different clinical symptoms, suffer more often from complications, and are at risk of social isolation after discharge when compared to their male counterparts. These results emphasize the need for further studies to evaluate a gender-based treatment algorithm in PAD.