Wang Jiarong, He Yazhou, Shu Chi, Zhao Jichun, Dubois Luc
Department of Surgery, West China School of Medicine, West China Hospital, Chengdu, Sichuan Province, China; Department of Vascular Surgery, West China Hospital, Chengdu, Sichuan Province, China.
Department of Surgery, West China School of Medicine, West China Hospital, Chengdu, Sichuan Province, China.
J Vasc Surg. 2017 Mar;65(3):889-906.e4. doi: 10.1016/j.jvs.2016.11.030.
The effect of gender on outcomes after lower extremity revascularization is controversial. The aim of our systemic review and meta-analysis was to evaluate the gender-related outcomes after peripheral vascular interventions.
We systematically searched MEDLINE, Embase, Cochrane Database, and Scopus to identify studies comparing outcomes after revascularization according to gender. A random-effects model was used to pool outcomes. Time-to-event data were reported using hazard ratios (HRs) and dichotomous data were presented using odds ratios (ORs).
Included were 40 studies. Pooling of short-term outcomes after intervention showed that women had significantly increased risks of 30-day mortality (OR, 1.31; 95% confidence interval [CI], 1.11-1.55; P = .001), amputation (OR, 1.07; 95% CI, 1.02-1.12; P = .002), early graft thrombosis (OR, 1.56; 95% CI, 1.28-1.90; P < .0001), embolization (OR, 1.64; 95% CI, 1.24-2.17; P = .0005), incisional site complication (OR, 1.56; 95% CI, 1.34-1.80; P < .0001), cardiac events (OR, 1.21; 95% CI, 1.16-1.26; P < .0001), stroke (OR, 1.35; 95% CI, 1.19-1.53; P < .0001), and pulmonary complication (OR, 1.07; 95% CI, 1.03-1.12; P = .0006). No significant differences were found between women and men for short-term reinterventions (OR, 1.06; 95% CI, 0.73-1.54; P = .74) and renal complications (OR, 1.03; 95% CI, 0.76-1.39; P = .86). No significant differences in long-term outcomes between women and men were found, with similar rates of cumulative survival (HR, 1.10; 95% CI, 0.97-1.24; P = .12), primary patency (HR, 1.14; 95% CI, 1.00-1.30; P = .06), secondary patency (HR, 1.07; 95% CI, 0.86-1.34; P = .54), and limb salvage (HR, 0.93; 95% CI, 0.70-1.24; P = .63). However, in the open surgery subgroup, women had significantly reduced survival compared with men (HR, 1.21; 95% CI, 1.01-1.44; P = .04).
Women have inferior short-term outcomes but similar long-term outcomes compared with men after lower limb revascularization. A higher treatment threshold may be warranted when considering intervening on women with symptomatic peripheral arterial disease owing to the increased risks of postprocedural mortality and complications.
性别对下肢血管重建术后结局的影响存在争议。我们进行系统评价和荟萃分析的目的是评估外周血管介入术后与性别相关的结局。
我们系统检索了MEDLINE、Embase、Cochrane数据库和Scopus，以识别根据性别比较血管重建术后结局的研究。采用随机效应模型汇总结局。事件发生时间数据采用风险比（HR）报告，二分数据采用比值比（OR）呈现。
纳入40项研究。干预后短期结局的汇总分析显示，女性30天死亡率（OR，1.31；95%置信区间[CI]，1.11 - 1.55；P = .001）、截肢（OR，1.07；95% CI，1.02 - 1.12；P = .002）、早期移植物血栓形成（OR，1.56；95% CI，1.28 - 1.90；P < .0001）、栓塞（OR，1.64；95% CI，1.24 - 2.17；P = .0005）、切口部位并发症（OR，1.56；95% CI，1.34 - 1.80；P < .0001）、心脏事件（OR，1.21；95% CI，1.16 - 1.26；P < .0001）、卒中（OR，1.35；95% CI，1.19 - 1.53；P < .0001）和肺部并发症（OR，1.07；95% CI，1.03 - 1.12；P = .0006）的风险显著增加。女性和男性在短期再次干预（OR，1.06；95% CI，0.73 - 1.54；P = .74）和肾脏并发症（OR，1.03；95% CI，0.76 - 1.39；P = .86）方面未发现显著差异。女性和男性在长期结局方面未发现显著差异，累积生存率（HR，1.10；95% CI，0.97 - 1.24；P = .12）、原发性通畅率（HR，1.14；95% CI，1.00 - 1.30；P = .06）、继发性通畅率（HR，1.07；95% CI，0.86 - 1.34；P = .54）和肢体挽救率（HR，0.93；95% CI，0.70 - 1.24；P = .63）相似。然而，在开放手术亚组中，女性与男性相比生存率显著降低（HR，1.21；95% CI，1.01 - 1.44；P = .04）。
下肢血管重建术后，女性的短期结局较差，但长期结局与男性相似。由于术后死亡和并发症风险增加，在考虑对有症状的外周动脉疾病女性进行干预时，可能需要更高的治疗阈值。
