Journal of vascular surgery
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Multicenter Study Comparative Study
Presentation, treatment, and outcome differences between men and women undergoing revascularization or amputation for lower extremity peripheral arterial disease.
Prior studies have suggested treatment and outcome disparities between men and women for lower extremity peripheral arterial disease after surgical bypass. Given the recent shift toward endovascular therapy, which has increasingly been used to treat claudication, we sought to analyze sex disparities in presentation, revascularization, amputation, and inpatient mortality. ⋯ There appears to be a preference to perform endovascular over surgical revascularization among women, who are older and have more advanced disease at presentation. Percutaneous transluminal angioplasty or stenting continues to be popular and is increasingly being performed in the outpatient setting. Amputation and in-hospital mortality rates have been declining, and women now have lower amputation but higher mortality rates than men. Recent improvements in outcomes are likely the result of a combination of improved medical management and risk factor reduction.
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Patients with severe chronic kidney disease (CKD) and peripheral vascular disease are at increased risk of major adverse limb events (MALEs) and death; however, patients with end-stage renal disease have been excluded in current objective performance goals. We evaluated the effect of severe (class 4 and 5) CKD on outcomes after infrainguinal endovascular arterial interventions. ⋯ CKD independently predicts early and late adverse events after a PVI, in particular, excessive mortality. CKD should figure prominently in clinical decision making for patients with peripheral vascular disease.
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Previous studies have shown that female gender is associated with increased morbidity and mortality after endovascular abdominal aortic aneurysm repair. The goal of this study was to assess the effect of gender on 30-day outcomes after thoracic endovascular aortic aneurysm repair (TEVAR) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. ⋯ Thirty-day unadjusted mortality after TEVAR for nonruptured thoracic aortic aneurysms is increased in women compared with men, but this univariate finding did not persist after risk adjustment. Multivariable analysis showed need for iliac artery exposure, age, and emergency surgery were independently associated with higher mortality rates. These results suggest a need for decreased device delivery size and improvements in endovascular technology.