PMID- 32561241
OWN - NLM
STAT- MEDLINE
DCOM- 20201130
LR  - 20221207
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 69
DP  - 2020 Nov
TI  - Increased Reintervention After Infrainguinal Revascularization for Chronic 
      Limb-Threatening Ischemia in Women.
PG  - 307-316
LID - S0890-5096(20)30507-0 [pii]
LID - 10.1016/j.avsg.2020.06.006 [doi]
AB  - BACKGROUND: The objective of this study was to determine if there are 
      gender-based differences in major adverse limb events after revascularization for 
      chronic limb-threatening ischemia (CLTI) and to identify potential associated 
      factors. METHODS: This was a single-center retrospective analysis of 151 patients 
      who underwent infrainguinal revascularization for CLTI between April 2013 and 
      December 2015. Only the first revascularized limb was included in patients with 
      bilateral CLTI. Demographic data and clinical outcomes were collected using 
      electronic medical records. RESULTS: The mean age was 68.1 +/- 12.1 years, and 55 
      of 151 (36%) were women. Women were less likely to carry a diagnosis of 
      hyperlipidemia (60% vs. 83%; P = 0.003), less likely to be on a statin medication 
      (58% vs. 81%; P = 0.004), and less likely to undergo an infrapopliteal 
      revascularization (60% vs. 77%; P = 0.04) compared with men. There were no 
      differences between genders with regard to the Society for Vascular Surgery Wound 
      Ischemia and Foot Infection stage at presentation or utilization of open versus 
      endovascular intervention. During the median follow-up time of 678 days 
      (interquartile range, 167-1277 days), 48 of 151 patients (32%) underwent 
      reintervention on the threatened limb and 23 of 151 patients (15%) underwent 
      major amputation. Women were more likely than men to need reintervention 
      (P = 0.02). There was no difference between genders for major amputation 
      (P = 0.48) or overall survival (P = 0.65). In a multivariable Cox proportional 
      hazards model for reintervention that included gender, preoperative body mass 
      index, hyperlipidemia, preoperative anticoagulation, and ischemia score >/=2 (all 
      P < 0.20 in univariate analysis), female gender (hazard ratio [HR], 1.96 
      [1.10-3.54]; P = 0.02) and hyperlipidemia (HR, 2.32 [1.07-5.03]; P = 0.03) were 
      significantly associated with increased rates of reintervention. CONCLUSIONS: 
      Women undergoing lower extremity revascularization for CLTI were more likely to 
      require reintervention compared with men but had similar rates of limb 
      preservation. Further study is required to understand potential causative factors 
      to improve treatment outcomes in women.
CI  - Copyright (c) 2020 Elsevier Inc. All rights reserved.
FAU - Wu, Bian
AU  - Wu B
AD  - Division of Vascular Surgery, Department of Surgery, University of California, 
      San Francisco, CA.
FAU - Lancaster, Elizabeth M
AU  - Lancaster EM
AD  - Division of Vascular Surgery, Department of Surgery, University of California, 
      San Francisco, CA.
FAU - Ramirez, Joel L
AU  - Ramirez JL
AD  - Division of Vascular Surgery, Department of Surgery, University of California, 
      San Francisco, CA.
FAU - Zarkowsky, Devin S
AU  - Zarkowsky DS
AD  - Division of Vascular Surgery, Department of Surgery, University of California, 
      San Francisco, CA.
FAU - Reyzelman, Alexander M
AU  - Reyzelman AM
AD  - Division of Vascular Surgery, Department of Surgery, University of California, 
      San Francisco, CA.
FAU - Gasper, Warren J
AU  - Gasper WJ
AD  - Division of Vascular Surgery, Department of Surgery, University of California, 
      San Francisco, CA.
FAU - Conte, Michael S
AU  - Conte MS
AD  - Division of Vascular Surgery, Department of Surgery, University of California, 
      San Francisco, CA.
FAU - Hiramoto, Jade S
AU  - Hiramoto JS
AD  - Division of Vascular Surgery, Department of Surgery, University of California, 
      San Francisco, CA. Electronic address: jade.hiramoto@ucsf.edu.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20200617
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Amputation, Surgical
MH  - Chronic Disease
MH  - Endovascular Procedures/*adverse effects
MH  - Female
MH  - *Health Status Disparities
MH  - *Healthcare Disparities
MH  - Humans
MH  - Ischemia/diagnosis/*surgery
MH  - Limb Salvage
MH  - Male
MH  - Middle Aged
MH  - Peripheral Arterial Disease/diagnosis/*surgery
MH  - Postoperative Complications/diagnosis/*surgery
MH  - *Reoperation
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Sex Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vascular Surgical Procedures/*adverse effects
EDAT- 2020/06/21 06:00
MHDA- 2020/12/01 06:00
CRDT- 2020/06/21 06:00
PHST- 2020/03/16 00:00 [received]
PHST- 2020/05/15 00:00 [revised]
PHST- 2020/06/05 00:00 [accepted]
PHST- 2020/06/21 06:00 [pubmed]
PHST- 2020/12/01 06:00 [medline]
PHST- 2020/06/21 06:00 [entrez]
AID - S0890-5096(20)30507-0 [pii]
AID - 10.1016/j.avsg.2020.06.006 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2020 Nov;69:307-316. doi: 10.1016/j.avsg.2020.06.006. Epub 2020 
      Jun 17.