PMID- 37349195
OWN - NLM
STAT- MEDLINE
DCOM- 20231106
LR  - 20231110
IS  - 1879-1484 (Electronic)
IS  - 0021-9150 (Linking)
VI  - 384
DP  - 2023 Nov
TI  - Sex-based differences in outcomes after lower extremity bypass for chronic 
      limb-threatening ischemia.
PG  - 117157
LID - S0021-9150(23)00233-2 [pii]
LID - 10.1016/j.atherosclerosis.2023.06.004 [doi]
AB  - BACKGROUND AND AIMS: Lower extremity bypass surgery is an effective treatment 
      option for patients with chronic limb-threatening ischemia (CLTI). Recent studies 
      have suggested that sex-based differences may impact patient outcomes following 
      lower extremity revascularization, however, results have been inconsistent. 
      METHODS: In this multicenter analysis, we retrospectively identified all 
      infrainguinal bypass procedures performed for CLTI from 2002 to 2021. Patients 
      were separated into two groups based on sex. Primary outcomes were major limb 
      amputation and reintervention for graft patency. RESULTS: Of 843 bypasses 
      performed over the study period, 347 (41.2%) patients were female. Racial/ethnic 
      distribution and medical comorbidities were similar across sex groups. Surgical 
      indications and operative details were also similar between groups, including 
      conduit type (49.9% autogenous), bypass target (65.4% infrageniculate), and 
      concurrent endarterectomy (38.9%). Female and male patients had similar hospital 
      length of stay (6 days [4-9] vs 6 days [4-9]), hospital readmission (25.6% vs 
      25.0%), and postoperative complications (p=NS each). Female patients had higher 
      major amputation rates (10.1% vs 6.3%, p=0.04) after one year, whereas 
      reintervention rates were similar between groups (26.2% vs 24.6%, p=NS). After 
      accounting for patient factors, female sex (odds ratio [OR] 1.02 [1.00-1.04]), 
      infrageniculate target (OR 1.02 [1.00-1.04]), and bypass for tissue loss (OR 1.02 
      [1.00-1.04]) were associated with major amputation after bypass (p<0.05 each). 
      CONCLUSIONS: Female sex is associated with a small but significant increase major 
      amputation after lower extremity bypass surgery for CLTI, despite similar 
      clinical presentation, medical comorbidities, and operative details. These data 
      support the increasingly recognized sex disparities in peripheral arterial 
      disease.
CI  - Copyright (c) 2023 Elsevier B.V. All rights reserved.
FAU - Kim, Young
AU  - Kim Y
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, Duke 
      University, Durham, NC, USA. Electronic address: y.kim@duke.edu.
FAU - Weissler, E Hope
AU  - Weissler EH
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, Duke 
      University, Durham, NC, USA.
FAU - Long, Chandler A
AU  - Long CA
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, Duke 
      University, Durham, NC, USA.
FAU - Williams, Zachary F
AU  - Williams ZF
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, Duke 
      University, Durham, NC, USA.
FAU - Dua, Anahita
AU  - Dua A
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, 
      Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
FAU - Southerland, Kevin W
AU  - Southerland KW
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, Duke 
      University, Durham, NC, USA.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20230607
PL  - Ireland
TA  - Atherosclerosis
JT  - Atherosclerosis
JID - 0242543
SB  - IM
MH  - Humans
MH  - Male
MH  - Female
MH  - Chronic Limb-Threatening Ischemia
MH  - Risk Factors
MH  - Retrospective Studies
MH  - Limb Salvage/adverse effects/methods
MH  - Ischemia/surgery
MH  - *Peripheral Arterial Disease
MH  - Treatment Outcome
MH  - Postoperative Complications/etiology
MH  - Lower Extremity/surgery
MH  - *Endovascular Procedures/adverse effects
OTO - NOTNLM
OT  - Chronic limb-threatening ischemia
OT  - Female sex
OT  - Peripheral artery disease
COIS- Declaration of competing interest The authors declare that they have no known 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this paper.
EDAT- 2023/06/23 01:10
MHDA- 2023/11/06 06:41
CRDT- 2023/06/22 21:54
PHST- 2022/10/31 00:00 [received]
PHST- 2023/06/01 00:00 [revised]
PHST- 2023/06/02 00:00 [accepted]
PHST- 2023/11/06 06:41 [medline]
PHST- 2023/06/23 01:10 [pubmed]
PHST- 2023/06/22 21:54 [entrez]
AID - S0021-9150(23)00233-2 [pii]
AID - 10.1016/j.atherosclerosis.2023.06.004 [doi]
PST - ppublish
SO  - Atherosclerosis. 2023 Nov;384:117157. doi: 10.1016/j.atherosclerosis.2023.06.004. 
      Epub 2023 Jun 7.