Vascular Surgery Section, Geriatric Surgery Clinic, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy.
J Vasc Surg. 2012 Aug;56(2):343-52. doi: 10.1016/j.jvs.2012.01.040. Epub 2012 May 9.
The role of gender on the outcome of infrainguinal arterial revascularization (IAR) for peripheral arterial occlusive disease remains uncertain. This study analyzed the outcome of IARs performed over 15 years, stratifying the results by sex.
Details of consecutive patients undergoing primary IAR for peripheral arterial occlusive disease from 1995 to 2009 at our institution were prospectively stored in a vascular registry. Demographics, risk factors, indications for surgery, inflow sources, outflow target vessels, types of conduit, and adverse outcomes were analyzed. Postoperative surveillance included clinical examination supplemented with duplex scans and ankle-brachial index measurements in all patients at discharge, 30 days, 6 months, and every 6 months thereafter. End points of the study, ie, patency, limb salvage, and survival rates, were assessed using Kaplan-Meier life-table analysis. The χ(2) or Fisher exact, Student t, and log-rank tests were used to establish statistical significance.
Our sample consisted of 1459 IARs performed in 1333 patients, comprising 496 women (37.2%; 531 IARs), who were a mean 3 years older than the men (74 vs 71 years; P < .001) and had a higher incidence of diabetes mellitus (52% vs 46%; P = .03) and surgery for limb salvage (91% vs 87%; P = .02). An autogenous vein conduit (great or small saphenous, or both, spliced, arm, or composite veins) was used in 87% of the IARs. No deaths occurred perioperatively (30 days). The major and minor complication rates were comparable between men and women. At 10 years, the primary patency rate was 47% in women vs 49% in men (P = .67), the assisted primary patency rate was, respectively, 53% vs 50% (P = .69), the secondary patency rate was 61% vs 61% (P = .66), limb salvage rate was 93% vs 91% (P = .54), and survival rate was 43% vs 49% (P = .65). Stratifying by type of conduit revealed no differences in patency or limb salvage rates.
Despite an older age and more advanced stages of disease on presentation in women, IAR performed in women can achieve patency and limb salvage rates statistically no different from those recorded in their male counterparts, supporting the conviction that sex per se does not influence the outcome of lower extremity revascularization.
性别在外周动脉闭塞性疾病的下肢动脉血运重建（IAR）结果中的作用仍不确定。本研究分析了 15 年来进行的 IAR 的结果，并按性别进行了分层。
前瞻性地将 1995 年至 2009 年在我院行初次 IAR 的连续患者的详细资料存储在血管登记处。分析患者的人口统计学、危险因素、手术适应证、流入源、流出靶血管、移植物类型和不良结局。所有患者术后随访包括临床检查，并在出院时、术后 30 天、6 个月和此后每 6 个月进行双功能超声和踝肱指数测量。本研究的终点包括通畅率、保肢率和生存率，使用 Kaplan-Meier 生命表分析进行评估。使用 χ(2)或 Fisher 确切检验、学生 t 检验和对数秩检验来确定统计学意义。
我们的样本包括 1333 名患者的 1459 次 IAR，其中 496 名女性（37.2%；531 次 IAR），平均年龄比男性大 3 岁（74 岁比 71 岁；P＜0.001），且糖尿病发生率更高（52%比 46%；P=0.03）和保肢手术（91%比 87%；P=0.02）。87%的 IAR 使用自体静脉移植物（大或小隐静脉，或两者拼接，肱动脉或复合静脉）。围手术期无死亡（30 天）。男性和女性的主要和次要并发症发生率相似。10 年时，女性的原发性通畅率为 47%，男性为 49%（P=0.67），辅助原发性通畅率分别为 53%和 50%（P=0.69），继发性通畅率分别为 61%和 61%（P=0.66），保肢率分别为 93%和 91%（P=0.54），生存率分别为 43%和 49%（P=0.65）。按移植物类型分层，通畅率和保肢率无差异。
尽管女性在就诊时年龄更大且疾病更晚期，但在女性中进行的 IAR 可以达到与男性相似的通畅率和保肢率，这支持了这样一种信念，即性别本身并不会影响下肢血运重建的结果。
