Rieß Henrik Christian, Debus Eike Sebastian, Heidemann Franziska, Stoberock Konstanze, Grundmann Reinhart T, Behrendt Christian-Alexander
1 Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Vasa. 2017 Jul;46(4):296-303. doi: 10.1024/0301-1526/a000634. Epub 2017 Apr 27.
Despite ongoing research concerning comorbidities and clinical presentation of peripheral arterial disease (PAD), the issue of gender associated differences in treatment is far from being settled.
This was a prospective, non-randomized multicentre study design. All patients suffering from intermittent claudication (IC) or critical limb ischaemia (CLI) were included.
A total of 2,798 procedures for symptomatic PAD in the infrainguinal region were recorded, with 1,696 (61.4 %) males. Distribution of comorbidities for patients with IC were gender-specifically different. Smoking was more common in men (41.9 vs. 31.9 %, p < .001), men had more often previous coronary heart disease (35.2 vs. 27.7 %, p = .007), and suffered more often from diabetes (33.9 vs. 28.2 %, p = .037). Women were generally older (71 vs. 77 years). Men were more prone to present with IC (46.9 vs. 43.6 %, p < .001) and ulcer/gangrene (43.6 vs. 41.2 %, p < .001). Women were more likely to present with rest pain (9.5 vs. 15.1 %, p < .001). Men were more often treated for a lesion below the knee (BTK) (21.1 vs. 14.9 %, p < .001), and females above the knee (ATK) (58.1 vs. 61.5 %, p < .001). Logistic regression analysis revealed a significant association of male gender and treatment for lesions BTK (OR 1.565, 95 % CI 1.281-1.913, p < .001). Dissections and bleeding complications were more often observed in females with IC (3.3 vs. 7.2 %, p = 0.003; 0.4 vs. 1.5 %, p = 0.044). Women were rather discharged to rehabilitation and had a longer hospital stay compared to men (3.4 vs. 8.9 %, p < .001; three vs. four days, p = .023).
The present study provides an overview on gender-specific differences in endovascular treatment of PAD. To date, available evidence on this topic is limited, emphasising the importance of further vascular research targeting this topic.
尽管针对外周动脉疾病（PAD）的合并症和临床表现的研究仍在进行，但治疗中性别相关差异的问题远未得到解决。
这是一项前瞻性、非随机的多中心研究设计。纳入所有患有间歇性跛行（IC）或严重肢体缺血（CLI）的患者。
共记录了2798例腹股沟下区域有症状PAD的手术，其中男性1696例（61.4%）。IC患者合并症的分布存在性别差异。吸烟在男性中更为常见（41.9%对31.9%，p<.001），男性既往患冠心病的比例更高（35.2%对27.7%，p = .007），患糖尿病的比例也更高（33.9%对28.2%，p = .037）。女性总体年龄更大（71岁对77岁）。男性更易出现间歇性跛行（46.9%对43.6%，p<.001）和溃疡/坏疽（43.6%对41.2%，p<.001）。女性更易出现静息痛（9.5%对15.1%，p<.001）。男性更多接受膝下（BTK）病变治疗（21.1%对14.9%，p<.001），女性更多接受膝上（ATK）病变治疗（58.1%对61.5%，p<.001）。逻辑回归分析显示男性性别与BTK病变治疗之间存在显著关联（比值比1.565，95%置信区间1.281 - 1.913，p<.001）。IC女性患者中更常观察到夹层和出血并发症（3.3%对7.2%，p = 0.003；0.4%对1.5%，p = 0.044）。与男性相比，女性更倾向于出院接受康复治疗且住院时间更长（3.4%对8.9%，p<.001；3天对4天，p = .023）。
本研究概述了PAD血管内治疗中的性别差异。迄今为止，关于该主题的现有证据有限，强调了针对此主题进一步开展血管研究的重要性。
