Despite more complications, women on par with men after PAD interventions

Women diagnosed with peripheral artery disease (PAD) were more likely to experience complications during peripheral vascular interventions than male counterparts, a study published June 17 in the Journal of the American College of Cardiology found. Nonetheless, both sexes had similar rates of procedural success.

Using the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PVI registry, researchers tracked 12,379 patients from 16 Michigan hospitals who were treated with lower extremity percutaneous peripheral vascular intervention (LE-PVI). Elizabeth A. Jackson, MD, MPH, of the cardiovascular medicine division at the University of Michigan in Ann Arbor, led the study team.

Forty-one percent of the patients were female. They found that men were more likely to be smokers, overweight or obese and have a history of coronary artery disease or hyperlipidemia. Women were more likely to be older, have comorbid conditions and complications such as bleeding. Men were more likely to have been previously prescribed ACE inhibitors and statins and more likely to have been treated with dual antiplatelet therapy, while women were more likely to be receive preprocedural heparin.

More women presented with critical limb ischemia, as opposed to men who were more likely to experience claudication symptoms. Women also had more multilevel disease. Women were less likely to receive stents as treatment, and more likely to have balloon therapy, including balloon with atherectomy.

Women also were more likely to experience higher rates of vascular access complications, unadjusted post-procedure transfusion and repeat PVI. They found no differences in the risks of in-hospital death, stroke/transient ischemic attack, amputation, or MI between men and women, though.

Jackson and colleagues stated, “Paradoxically, female sex was associated with superior technical success but more procedural complications that resulted in similar rates of procedural success associated with LE-PVI.”

The trend of lower prescription rates continued post-surgery. 

Jackson et al stated that while these observations were localized to the study hospitals, they were consistent with findings in other studies. They suggested that further efforts to design improved interventions and therapies were needed to provide quality medical care for all PAD patients and should include “enhanced efforts to understand and ameliorate PVI-associated complications, in particular bleeding and vascular complications among women.”