Gender Differences in the Outcome of Endovascular Interventions for PAD - Is there a Difference Between Men and Women Treated with Angioplasty or Angioplasty and Stenting?

Objective: The expression and presentation of peripheral arterial disease(PAD) differs between men and women, however the outcomes based on endovascular technique and gender are unknown. This study will assess the outcomes of females compared to males treated with lower extremity interventions (PTA alone or PTA+Stent) in order to determine the optimal therapy.
Methods: We performed a prospective study evaluating the outcomes of PTA and PTA+Stent for PAD. Indications for intervention included claudication or chronic limb ischemia(CLI). Patients were followed clinically and with noninvasive laboratory testing for 30 months. Primary, primary-assisted and secondary patency and limb salvage were the primary endpoints. Lesion location and length were evaluated for both groups. Statistical analysis was performed using Kaplan-Meier and log-rank tests.
Results: 984 lesions were analyzed in 407 patients between 2004 and 2009. 172 patients were female and 235 were male. Of these lesions, 511 were treated with primary PTA and 473 were treated with PTA+Stent. There was no statistical difference between the lesion distribution and characteristics of the PTA alone and PTA+Stent groups based on gender. The primary, primary-assisted, secondary patency and limb salvage in females treated with PTA alone was significantly improved (P < .005) at all time points compared with males undergoing PTA alone(Table). When female and male outcomes following PTA+Stent were compared, outcomes were similar for primary, primary-assisted and secondary patency at all intervals. Males had an improvement when comparing PTA+Stent to PTA alone at all time intervals and patencies (P<.05). Additionally, there was a statistically significant advantage for limb salvage in women treated with PTA compared to men.
Conclusions: Women have significantly improved primary, primary-assisted, secondary patency and limb salvage rates compared with men following treatment with PTA and this should be the primary endovascular treatment option for women, however men may be better managed with primary PTA+Stent.
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