Purpose: To evaluate gender-related long-term outcomes in patients undergoing stent treatment of femoropopliteal peripheral artery disease. Methods: Between September 2006 and August 2010, all 517 patients (333 men and 184 women; mean age 70.6 years) undergoing primary stent placement in femoropopliteal atherosclerotic lesions at 2 European vascular centers were prospectively enrolled in the study. The main study outcome was primary stent patency. Secondary outcomes included secondary patency, limb salvage, and all-cause mortality. Results: Women had a higher incidence of critical limb ischemia (32.1% vs. 16.9%, p<0.001). Lesion characteristics according to the TransAtlantic Inter-Society Consensus (TASC) classification were comparable in both genders (p=0.52), although total occlusions and popliteal involvement were observed more frequently in female patients (p=0.043 and p=0.001, respectively). Both genders showed similar 5-year primary patency rates (64.3% men vs. 58.1% women, p=0.11). A statistically significant difference was observed concerning the secondary patency rates in favor of men (71.9% vs. 66.8% at 5 years, p=0.005). Limb salvage rates did not vary between the groups (p=0.83). Survival rates were comparable at 5 years (83.3% and 82.6% for men and women, respectively; p=0.63), although female patients were older at their presentation (68.5 vs. 74.3 years, p<0.001). Female gender was an independent risk factor for restenosis for TASC C/D lesions (primary patency rate 39.8% in women vs. 62.0% in men; p=0.002). Finally, critical limb ischemia was an independent risk factor for restenosis in women (odds ratio 1.5). Conclusion: Female gender was associated with a higher prevalence of critical limb ischemia, poorer secondary patency, and more frequent restenosis in TASC C/D lesions. Endovascular treatment of femoropopliteal lesions provides equal results between genders in terms of primary stent patency in the long term.
FowkesFGRudanDRudanI. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382:1329–1340.
2.
ChungSCGedeborgRNicholasO. Acute myocardial infarction: a comparison of short-term survival in national outcome registries in Sweden and the UK. Lancet. 2014;383:1305–1312.
3.
McCoachCEArmstrongEJSinghS. Gender-related variation in the clinical presentation and outcomes of critical limb ischemia. Vasc Med. 2013;18:19–26.
4.
RothwellPMSlatteryJWarlowCP. Clinical and angiographic predictors of stroke and death from carotid endarterectomy: systematic review. BMJ. 1997;315:1571–1577.
5.
GrootenboerNvan SambeekMRArendsLR. Systematic review and meta-analysis of sex differences in outcome after intervention for abdominal aortic aneurysm. Br J Surg. 2010;97:1169–1179.
6.
EnzlerMARuossMSeifertB. The influence of gender on the outcome of arterial procedures in the lower extremity. Eur J Vasc Endovasc Surg. 1996;11:446–452.
7.
LeTYAshtonAWMardiniM. Role of androgens in sex differences in cardiac damage during myocardial infarction. Endocrinology. 2014;155:568–575.
8.
OrtmannJNüeschETraupeT. Gender is an independent risk factor for distribution pattern and lesion morphology in chronic critical limb ischemia. J Vasc Surg. 2012;55:98–104.
9.
OrtmannJNüeschECajöriG. Benefit of immediate revascularization in women with critical limb ischemia in an intention-to-treat analysis. J Vasc Surg. 2011;54:1668–1678.
10.
OslerMMårtenssonSPrescottE. Impact of gender, co-morbidity and social factors on labour market affiliation after first admission for acute coronary syndrome. A cohort study of Danish patients 2001-2009. PLoS One. 2014;9:e86758.
11.
NgyuenLLBrahmanandamSBandykDF. Female gender and oral anticoagulants are associated with wound complications in lower extremity vein bypass: an analysis of 1404 operations for critical limb ischemia. J Vasc Surg. 2007;46:1191–1197.
12.
MatsiPJManninenHI. Complications of lower-limb percutaneous transluminal angioplasty: a prospective analysis of 410 procedures on 295 consecutive patients. Cardiovasc Intervent Radiol. 1998;21:361–366.
13.
PulliRDorigoWPratesiG. Gender-related outcomes in the endovascular treatment of infrainguinal arterial obstructive disease. J Vasc Surg. 2012;55:105–112.
14.
Bechter-HuglBFalkensammerJGornyO. The influence of gender on patency rates after iliac artery stenting. J Vasc Surg. 2014;59:1588–1596.
15.
TyeAHanDKTadrosRO. Percutaneous intervention for infrageniculate arterial disease in women may be associated with better outcomes when compared to men. J Vasc Surg. 2013;57:706–713.
16.
DaviesMGBismuthJSaadWE. Outcomes of reintervention for recurrent disease after percutaneous iliac angioplasty and stenting. J Endovasc Ther. 2011;18:169–180.
17.
TandjungKBasalusMWSenH. Women treated with second-generation zotarolimus-eluting resolute stents and everolimus-eluting xience V stents: insights from the gender-stratified, randomized, controlled TWENTE trial. Catheter Cardiovasc Interv. 2013;82:396–405.
18.
BujaPD’AmicoGFacchinM. Gender-related differences of diabetic patients undergoing percutaneous coronary intervention with drug-eluting stents: a real-life multicenter experience. Int J Cardiol. 2013;168:139–143.
19.
TadrosROFariesPLRocha-SinghKJ. The impact of sex on angioplasty and primary stenting for femoropopliteal occlusive disease: results of the DURABILITY II trial. Ann Vasc Surg. 2014;28:1-9.
20.
LindgrenHGottsäterAHermanssonK. Gender differences in outcome after stent treatment of lesions in the femoropopliteal segment. Scand J Surg. 2012;101:177–183.
21.
LoRCBensleyRPDahlbergSE. Presentation, treatment, and outcome differences between men and women undergoing revascularization or amputation for lower extremity peripheral arterial disease. J Vasc Surg. 2014;59:409–418.
