The effect of gender on outcomes after lower extremity revascularization.

OBJECTIVE

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.

METHODS

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).

RESULTS

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).

CONCLUSIONS

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.