Abstract
BACKGROUND: Sex-based differences in outcomes of lower extremity revascularization (LER) for patients with peripheral arterial disease (PAD) remain a focus of interest to improve outcomes. Recent studies observed increased bleeding in females undergoing endovascular LER. This contemporary study examines differences in perioperative complications of open and endovascular LER between the sexes. METHODS: A retrospective chart review of PAD patients undergoing LER in a tertiary center between 2013 and 2020 was performed. Patient characteristics and indications of initial procedures were compared. Perioperative (30-day) complications of initial and subsequent LER were analyzed. RESULTS: A total of 1,987 (62.3% males) patients underwent 4,623 LER (85% endovascular). At initial presentation, females were more likely to be older, to belong to extreme age groups (premature PAD ≤50 or very old ≥81), and to be African American. Males were more likely to have smoking history, diabetes, chronic renal insufficiency, and coronary artery disease. Females were less likely to be on aspirin and statin. There were no differences in indication or procedure type. Females had a significantly increased risk of early thrombosis compared to males (1.7% vs. 1%, P = 0.027) but there was no difference in major amputation (1.2% vs. 1.7%, P = 0.222). Males were more likely to develop wound infections (5% vs. 3.3% P = 0.005) and had a trend toward higher myocardial infarction after LER which did not reach significance (0.8% vs. 0.5%, P = 0.276). There was no difference in hematoma (1.6% vs. 1.2%, P = 0.235) and bleeding (1.5% vs. 1.3%, P = 0.575). There was no significant difference between sexes in overall morbidity (16.7% vs. 17.3%, P = 0.577) but there was a trend toward higher mortality in females compared to males (1.6% vs. 1%, P = 0.056). CONCLUSION: This study highlights sex differences in the presentation and outcomes of patients undergoing LER for PAD. Females are older, but males have more comorbidities. Females are more likely to have thrombosis compared to males in the perioperative period.