Wu Bian, Lancaster Elizabeth M, Ramirez Joel L, Zarkowsky Devin S, Reyzelman Alexander M, Gasper Warren J, Conte Michael S, Hiramoto Jade S
Division of Vascular Surgery, Department of Surgery, University of California, San Francisco, CA.
Division of Vascular Surgery, Department of Surgery, University of California, San Francisco, CA.
Ann Vasc Surg. 2020 Nov;69:307-316. doi: 10.1016/j.avsg.2020.06.006. Epub 2020 Jun 17.
The objective of this study was to determine if there are gender-based differences in major adverse limb events after revascularization for chronic limb-threatening ischemia (CLTI) and to identify potential associated factors.
This was a single-center retrospective analysis of 151 patients who underwent infrainguinal revascularization for CLTI between April 2013 and December 2015. Only the first revascularized limb was included in patients with bilateral CLTI. Demographic data and clinical outcomes were collected using electronic medical records.
The mean age was 68.1 ± 12.1 years, and 55 of 151 (36%) were women. Women were less likely to carry a diagnosis of hyperlipidemia (60% vs. 83%; P = 0.003), less likely to be on a statin medication (58% vs. 81%; P = 0.004), and less likely to undergo an infrapopliteal revascularization (60% vs. 77%; P = 0.04) compared with men. There were no differences between genders with regard to the Society for Vascular Surgery Wound Ischemia and Foot Infection stage at presentation or utilization of open versus endovascular intervention. During the median follow-up time of 678 days (interquartile range, 167-1277 days), 48 of 151 patients (32%) underwent reintervention on the threatened limb and 23 of 151 patients (15%) underwent major amputation. Women were more likely than men to need reintervention (P = 0.02). There was no difference between genders for major amputation (P = 0.48) or overall survival (P = 0.65). In a multivariable Cox proportional hazards model for reintervention that included gender, preoperative body mass index, hyperlipidemia, preoperative anticoagulation, and ischemia score ≥2 (all P < 0.20 in univariate analysis), female gender (hazard ratio [HR], 1.96 [1.10-3.54]; P = 0.02) and hyperlipidemia (HR, 2.32 [1.07-5.03]; P = 0.03) were significantly associated with increased rates of reintervention.
Women undergoing lower extremity revascularization for CLTI were more likely to require reintervention compared with men but had similar rates of limb preservation. Further study is required to understand potential causative factors to improve treatment outcomes in women.
本研究的目的是确定在慢性肢体威胁性缺血（CLTI）血管重建术后主要不良肢体事件是否存在性别差异，并识别潜在的相关因素。
这是一项对2013年4月至2015年12月期间因CLTI接受股动脉以下血管重建术的151例患者进行的单中心回顾性分析。双侧CLTI患者仅纳入首次接受血管重建的肢体。使用电子病历收集人口统计学数据和临床结局。
平均年龄为68.1±12.1岁，151例患者中有55例（36%）为女性。与男性相比，女性患高脂血症的可能性较小（60%对83%；P=0.003），服用他汀类药物的可能性较小（58%对81%；P=0.004），接受腘动脉以下血管重建的可能性较小（60%对77%；P=0.04）。在就诊时血管外科协会伤口缺血和足部感染分期或开放与血管腔内干预的使用方面，性别之间没有差异。在678天的中位随访时间（四分位间距，167-1277天）内，151例患者中有48例（32%）对受威胁肢体进行了再次干预，151例患者中有23例（15%）接受了大截肢。女性比男性更有可能需要再次干预（P=0.02）。在大截肢（P=0.48）或总生存率（P=0.65）方面，性别之间没有差异。在一个包括性别、术前体重指数、高脂血症、术前抗凝和缺血评分≥2（单变量分析中所有P<0.20）的再次干预多变量Cox比例风险模型中，女性性别（风险比[HR]，1.96[1.10-3.54]；P=0.02）和高脂血症（HR，2.32[1.07-5.03]；P=0.03）与再次干预率增加显著相关。
与男性相比，因CLTI接受下肢血管重建的女性更有可能需要再次干预，但肢体保留率相似。需要进一步研究以了解潜在的致病因素，以改善女性的治疗结局。
