Percutaneous intervention for infrainguinal occlusive disease in women

Equivalent outcomes despite increased severity of disease compared with men

Brian G. DeRubertis, Angela Vouyouka, Soo J. Rhee, Joseph Califano, John K Karwowski, Niren Angle, Peter L. Faries, K. Craig Kent

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Objectives: Experience with open surgical bypass suggests similar overall outcomes in women compared with men, but significantly increased risk of wound complications. Percutaneous treatment of lower extremity occlusive disease is therefore an attractive alternative in women, although it is not clear whether there is a difference in outcomes between women and men treated with this technique. We sought to determine the results and predictors of failure in women treated by percutaneous intervention. Methods: Percutaneous infrainguinal revascularization was performed on 309 women between 2001 and 2006. Procedures, complications, demographics, comorbidities, and follow-up data were entered into a prospective database for review. Patency was assessed primarily by duplex ultrasonography. Outcomes were expressed by Kaplan-Meier curves and compared by log-rank analysis. Results: A total of 447 percutaneous interventions performed in 309 women were analyzed and compared with 553 interventions in men. Mean age in women was 73.2 years; comorbidities included hypertension (HTN) (86%), diabetes melitus (DM) (58%), chronic renal insufficiency (CRI) (15%), hemodialysis (7%), hypercholesterolemia (52%), coronary artery disease (CAD) (42%), and tobacco use (47%). Indications in women included claudication (38.0%), rest pain (18.8%), and tissue loss (43.2%). Overall primary & secondary patency and limb-salvage rates for women were 38% ± 4%, 66% ± 3%, and 80% ± 4% at 24 months. In this patient sample, women were significantly more likely than men to present with limb-threatening ischemia (61.6% vs 47.3%, P < 0.001) and have lesions of TASC C and D severity (71.4% vs 61.7%, P < .005). However, there were no significant differences in primary and secondary patency rates or limb-salvage rates between genders. Furthermore, while women with limb-threat, diabetes, and advanced TASC severity lesions were at increased risk of failure overall, there were no differences between women and men with these characteristics. Conclusions: Percutaneous infrainguinal revascularization is a very effective modality in women with lower extremity occlusive disease. Although women in this sample were more likely to present with limb-threat than men, patency and limb-salvage rates were equivalent between genders, even in high-risk subsets such as diabetics or those with lesions of increased TASC severity.

Original languageEnglish (US)
Pages (from-to)150-158
Number of pages9
JournalJournal of Vascular Surgery
Volume48
Issue number1
DOIs
StatePublished - Jul 2008
Externally publishedYes

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Limb Salvage
Extremities
Comorbidity
Lower Extremity
Nociceptive Pain
Tobacco Use
Hypercholesterolemia
Chronic Renal Insufficiency
Renal Dialysis
Coronary Artery Disease
Ultrasonography
Ischemia
Demography
Databases
Hypertension
Wounds and Injuries
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Percutaneous intervention for infrainguinal occlusive disease in women : Equivalent outcomes despite increased severity of disease compared with men. / DeRubertis, Brian G.; Vouyouka, Angela; Rhee, Soo J.; Califano, Joseph; Karwowski, John K; Angle, Niren; Faries, Peter L.; Kent, K. Craig.

In: Journal of Vascular Surgery, Vol. 48, No. 1, 07.2008, p. 150-158.

Research output: Contribution to journalArticle

DeRubertis, Brian G. ; Vouyouka, Angela ; Rhee, Soo J. ; Califano, Joseph ; Karwowski, John K ; Angle, Niren ; Faries, Peter L. ; Kent, K. Craig. / Percutaneous intervention for infrainguinal occlusive disease in women : Equivalent outcomes despite increased severity of disease compared with men. In: Journal of Vascular Surgery. 2008 ; Vol. 48, No. 1. pp. 150-158.
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T2 - Equivalent outcomes despite increased severity of disease compared with men

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AU - Rhee, Soo J.

AU - Califano, Joseph

AU - Karwowski, John K

AU - Angle, Niren

AU - Faries, Peter L.

AU - Kent, K. Craig

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N2 - Objectives: Experience with open surgical bypass suggests similar overall outcomes in women compared with men, but significantly increased risk of wound complications. Percutaneous treatment of lower extremity occlusive disease is therefore an attractive alternative in women, although it is not clear whether there is a difference in outcomes between women and men treated with this technique. We sought to determine the results and predictors of failure in women treated by percutaneous intervention. Methods: Percutaneous infrainguinal revascularization was performed on 309 women between 2001 and 2006. Procedures, complications, demographics, comorbidities, and follow-up data were entered into a prospective database for review. Patency was assessed primarily by duplex ultrasonography. Outcomes were expressed by Kaplan-Meier curves and compared by log-rank analysis. Results: A total of 447 percutaneous interventions performed in 309 women were analyzed and compared with 553 interventions in men. Mean age in women was 73.2 years; comorbidities included hypertension (HTN) (86%), diabetes melitus (DM) (58%), chronic renal insufficiency (CRI) (15%), hemodialysis (7%), hypercholesterolemia (52%), coronary artery disease (CAD) (42%), and tobacco use (47%). Indications in women included claudication (38.0%), rest pain (18.8%), and tissue loss (43.2%). Overall primary & secondary patency and limb-salvage rates for women were 38% ± 4%, 66% ± 3%, and 80% ± 4% at 24 months. In this patient sample, women were significantly more likely than men to present with limb-threatening ischemia (61.6% vs 47.3%, P < 0.001) and have lesions of TASC C and D severity (71.4% vs 61.7%, P < .005). However, there were no significant differences in primary and secondary patency rates or limb-salvage rates between genders. Furthermore, while women with limb-threat, diabetes, and advanced TASC severity lesions were at increased risk of failure overall, there were no differences between women and men with these characteristics. Conclusions: Percutaneous infrainguinal revascularization is a very effective modality in women with lower extremity occlusive disease. Although women in this sample were more likely to present with limb-threat than men, patency and limb-salvage rates were equivalent between genders, even in high-risk subsets such as diabetics or those with lesions of increased TASC severity.

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