Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA.
Division of Vascular and Endovascular Surgery, Maine Medical Center, Portland, ME.
Ann Vasc Surg. 2022 Oct;86:85-93. doi: 10.1016/j.avsg.2022.05.036. Epub 2022 Jul 7.
Intermittent claudication (IC) is a commonly treated vascular condition. Patient sex has been shown to influence outcomes of interventions for other vascular disorders; however, whether outcomes of interventions for IC vary by sex is unclear. We sought to assess the association of patient sex with outcomes after IC interventions.
The Vascular Quality Initiative was queried from 2010-2020 for all peripheral endovascular interventions (PVI), infra-inguinal bypasses (IIB), and supra-inguinal bypasses (SIB) for any degree IC. Univariable and multivariable analyses compared peri-operative and long-term outcomes by patient sex.
There were 24,701 female and 40,051 male patients undergoing PVI, 2,789 female and 6,525 male patients undergoing IIB, and 1,695 female and 2,370 male patients undergoing SIB for IC. Guideline-recommended pre-operative medical therapy differed with female patients less often prescribed aspirin for PVI (73.4% vs. 77.3%), IIB (71.5% vs. 74.8%), and SIB (70.9% vs. 74.3%) or statins for PVI (71.8% vs. 76.7%) and IIB (73.1% vs. 76.0%) (all P < 0.05). Female compared with male patients had lower 1-year reintervention-free survival after PVI (84.4% ± 0.3% vs. 86.3% ± 0.2%, P < 0.001), IIB (79.0% ± 0.9% vs. 81.2% ± 0.6%, P = 0.04), and SIB (89.4% ± 0.9% vs. 92.6% ± 0.7%, P = 0.005), but similar amputation-free survival and survival across all procedures. Multivariable analysis confirmed that female sex was associated with increased 1-year reintervention for PVI (HR 1.16, 95% CI 1.09-1.24, P < 0.001), IIB, (HR 1.16, 95% CI 1.03-1.31, P = 0.02), and SIB (HR 1.60, 95% CI 1.20-2.13, P = 0.001).
Female patients undergoing interventions for IC were less often pre-operatively medically optimized than male patients, though the difference was small. Furthermore, female sex was associated with more reinterventions after interventions. Interventionists treating female patients should increase their efforts to maximize medical therapy. Future research should clarify reasons for poorer intervention durability in female patients.
间歇性跛行（IC）是一种常见的血管疾病。已有研究表明，患者性别会影响其他血管疾病干预措施的效果；然而，IC 干预措施的效果是否因性别而异尚不清楚。我们旨在评估患者性别与 IC 干预后结局的相关性。
2010 年至 2020 年，我们对所有血管质量倡议（VQI）中接受任何程度 IC 治疗的外周血管腔内干预（PVI）、下肢旁路转流术（IIB）和锁骨下旁路转流术（SIB）患者进行了检索。采用单变量和多变量分析比较了患者性别与围手术期和长期结局。
共纳入 24701 名女性和 40051 名男性接受 PVI、2789 名女性和 6525 名男性接受 IIB、1695 名女性和 2370 名男性接受 SIB 治疗 IC。指南推荐的术前药物治疗也存在差异，女性患者接受 PVI（73.4% vs. 77.3%）、IIB（71.5% vs. 74.8%）和 SIB（70.9% vs. 74.3%）时阿司匹林处方率较低，而接受 PVI（71.8% vs. 76.7%）和 IIB（73.1% vs. 76.0%）时他汀类药物处方率较低（均 P<0.05）。与男性患者相比，女性患者在接受 PVI（84.4%±0.3% vs. 86.3%±0.2%，P<0.001）、IIB（79.0%±0.9% vs. 81.2%±0.6%，P=0.04）和 SIB（89.4%±0.9% vs. 92.6%±0.7%，P=0.005）后 1 年的再干预无复发生存率较低，但截肢和所有手术的生存率相似。多变量分析证实，女性性别与 PVI（HR 1.16，95%CI 1.09-1.24，P<0.001）、IIB（HR 1.16，95%CI 1.03-1.31，P=0.02）和 SIB（HR 1.60，95%CI 1.20-2.13，P=0.001）后 1 年的再干预风险增加相关。
与男性患者相比，接受 IC 治疗的女性患者术前药物治疗优化程度较低，但差异较小。此外，女性性别与干预后更多的再干预有关。治疗女性患者的介入医生应加大努力，最大限度地提高药物治疗效果。未来的研究应明确女性患者介入治疗耐久性较差的原因。
