The influence of sex disparities on outcomes after infrainguinal endovascular revascularization in patients with symptomatic peripheral arterial disease

BACKGROUND: Several reports have addressed sex disparities in the outcomes of patients with peripheral arterial disease (PAD) after endovascular revascularization, leading to inconclusive findings and contrasting data. Here, we report our results in patients with PAD who underwent endovascular infrainguinal revascularization, focusing on possible sex influences on outcomes. METHODS: We conducted a retrospective analysis of patients who underwent endovascular procedures for symptomatic PAD in our department between January 2018 and November 2021. Outcomes were analyzed until December 2022. Primary endpoints included primary patency, freedom from major adverse limb events (MALE; major amputation, intervention to restore patency), and freedom from major adverse cardiovascular events (MACE). Data on demographics, comorbidities, clinical limb presentation, vessel target characteristics, and run-off quality before and after the procedure were collected and analyzed. RESULTS: We identified 131 limbs in 124 men and 93 limbs in 92 women revascularized by endovascular means with median follow-up of 36±12.3 months. The mean age of the groups was 73±4 years and 80±5 years for male and female, respectively. Additionally, there were more octogenarians in the female group (P=0.00001). In males, there was a higher prevalence of renal disease (P=0.005), end-stage renal disease (P=0.046), chronic obstructive pulmonary disease (P<0.038), coronary artery disease (P=0.0005), and neoplasia (P=0.014). Most patients presented with critical limb-threatening ischemia (Rutherford 4-6) at 90% vs. 93.5% in the male and female groups, respectively, with no significant differences. In the female group the superficial femoral artery (SFA) was the prevalent vessel target for treatment (P=0.036), whereas sole tibial vessels (below-the-knee, BTK) were treated mainly in the males (P=0.01). There was no significant difference in runoff quality before and after the procedure. Freedom from MACE at four years was 77% vs. 82% (P=0.647) and freedom from MALE was 73% vs. 81% (P=0.515) for male and female groups, respectively. CONCLUSIONS: No significant sex-related differences were observed regarding the outcomes after infrainguinal endovascular revascularization. Differences were mainly related to demographic data and comorbidities, which did not influence freedom from MACE. Another difference was the vessel target treated, mainly, the sfa in females and BtK in males. However, there were no differences in freedom from MalE.