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Gender discrepancy observed in outcomes of CLI open surgery
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The 6-year survival rate of infrainguinal open surgery for critical limb ischemia was significantly lower in women compared with men, with a comparable disparity reported in rates of primary patency and limb salvage.
In the retrospective study, researchers enrolled all patients who underwent infrainguinal open surgery for critical limb ischemia (CLI) from 2003 to 2012, and evaluated survival, limb salvage and primary patency rates. Researchers excluded patients with infrainguinal lesions that were associated with suprainguinal lesions.
In all, 269 women (mean age, 76 years) and 315 men (mean age, 71 years) were enrolled, totaling 584 patients and 658 infrainguinal open surgeries.
At 6 years, survival was 53.5% in women vs. 70.9% in men (P < .001). Similarly, 6-year rates of primary patency (35.9% vs. 52.4%; P < .001) and limb salvage (54.3% vs. 81.1%; P < .001) also were lower in women.
In an analysis adjusted for age and sex, female sex independently predicted death (HR = 1.5), thrombosis (HR = 2.37) and limb loss (HR = 7.05).
The researchers noted that although a gender-related disparity in open surgical revascularization for CLI has been clearly observed, other factors also correlate and influence outcomes and “female gender might be considered a risk factor per se, because women are more often older at presentation and present with bilateral lesions.”
Further, the results highlight the need for further and longer follow-up investigations, and justify the American Heart Association’s recent call to action concerning women and peripheral arterial disease, according to the researchers.
“The results show worse immediate and long-term outcomes in women, justifying intensive care in [the] preoperative period, but also better follow-up,” they wrote. – by Brian Ellis
Disclosure: The researchers report no relevant financial disclosures.
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