Department of Vascular Medicine, Working Group GermanVasc, University Heart Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Eur J Vasc Endovasc Surg. 2019 May;57(5):658-665. doi: 10.1016/j.ejvs.2018.10.021. Epub 2019 Mar 20.
The worldwide prevalence of peripheral artery disease (PAD) is increasing and endovascular revascularisation (ER) has become the primary invasive treatment option. This study aims to illuminate gender disparities in ER of PAD.
This is a retrospective, cross sectional study design. All inpatient invasive, percutaneous endovascular treatments of PAD conducted in the metropolitan area of Hamburg (Germany) were collected consecutively between 01/2004 and 12/2015. Relevant socio-demographic risk factors, technical assessments, procedural details, and in hospital outcomes were collected and subsequently analysed.
A total of 23,715 ERs were identified (39.7% females). Female patients were older (74 vs. 70 years, p < .001) and more often suffered from rest pain (12.0% vs. 9.7%, p < .001) at the time of presentation. No differences were found for index lesion complexity (Trans-Atlantic Inter-Society Consensus classes) and the ankle brachial index was less often stated not to be valid in females (5.9% vs. 7.1%, p = .005 for intermittent claudication; 28.5% vs. 32.0%, p = .001 for chronic limb threatening ischaemia, CLTI). If the ER was performed for CLTI, crural vessels below the knee were less often revascularised in females (32.2% vs. 42.7%, p < .001). Peri-operative major bleeding complications including pseudoaneurysms occurred twice as often in females, and female gender was an independent predictor of bleeding complications in the adjusted analyses (OR 2.32, 95% CI 1.49-3.64, p < .001 for IC; OR 1.67, 95% CI 1.10-2.53, p = .017 for CLTI). Lastly, females were more often transferred to nursing homes when compared with males (0.3% vs. 0%, p = .001 for IC; 2.5% vs. 1.2%, p < .001 for CLTI).
In this study considering percutaneous ER for PAD, female patients were older, had different clinical symptoms, suffered more often from complications, and were at risk of social isolation after discharge when compared with their male counterparts. These results emphasise the need for further studies to evaluate a gender based treatment algorithm in PAD.
全球外周动脉疾病 (PAD) 的患病率正在上升，血管腔内血运重建 (ER) 已成为主要的侵入性治疗选择。本研究旨在阐明 PAD 血管腔内血运重建中的性别差异。
这是一项回顾性、横断面研究设计。2004 年 1 月至 2015 年 12 月期间，连续收集了汉堡大都市地区（德国）所有住院的、经皮腔内治疗 PAD 的病例。收集了相关的社会人口统计学风险因素、技术评估、手术细节和住院结果，并进行了分析。
共确定了 23715 例 ER （女性占 39.7%）。女性患者年龄更大（74 岁 vs. 70 岁，p <.001），就诊时更常出现静息痛（12.0% vs. 9.7%，p <.001）。指数病变复杂性（跨大西洋介入协会共识分类）无差异，女性踝肱指数的有效性陈述较少（间歇性跛行：5.9% vs. 7.1%，p =.005；慢性肢体威胁性缺血，CLTI：28.5% vs. 32.0%，p =.001）。如果 ER 是为 CLTI 进行的，女性股下段血管的再血管化程度较低（32.2% vs. 42.7%，p <.001）。围手术期主要出血并发症，包括假性动脉瘤，在女性中发生的频率是男性的两倍，并且在调整后的分析中，女性性别是出血并发症的独立预测因素（IC 的 OR 2.32，95%CI 1.49-3.64，p <.001；CLTI 的 OR 1.67，95%CI 1.10-2.53，p =.017）。最后，与男性相比，女性在出院后更常被转移到疗养院（IC：0.3% vs. 0%，p =.001；CLTI：2.5% vs. 1.2%，p <.001）。
在这项考虑经皮 PAD 血管腔内血运重建的研究中，与男性相比，女性患者年龄更大，临床表现不同，更常发生并发症，并且出院后有社会隔离的风险。这些结果强调需要进一步研究，以评估 PAD 中的基于性别的治疗方案。
