Comparative Analysis of Reinterventions After Lower Extremity Revascularization Between the Sexes

Reinterventions after lower extremity revascularization (LER) for peripheral arterial disease (PAD) are common. Previous studies have observed an increased reintervention rate in women compared to men, however the frequency of reinterventions between the sexes has not been reported. This study highlights sex differences in perioperative as well as long-term outcomes of LER focusing on reintervention patterns. A retrospective analysis of patients undergoing LER for PAD between 2013 and 2020 at a tertiary care center was performed. Comorbidities, perioperative, and long-term outcomes were compared between male and female patients. The rates and frequency of reinterventions were assessed. Kaplan-Meier curves for major adverse limb event (MALE)-free survival were derived. The study included 1987 patients undergoing LER and 37% (n = 736) were females. Females were more likely to be older (70.5 vs 69.2; P = .015) and Black (18% vs 12.3%; P = .003). Males were more likely to have a higher prevalence of comorbidities including coronary artery disease (59.3% vs 45.6%; P < .0001), diabetes (60.2% vs 51.9%; P = .0003), and chronic renal insufficiency (20.1% vs 15.8%; P = .016). Males were also more likely to have undergone a prior open procedure (12.8% vs 8.7%; P = .006) and be on aspirin (76.7% vs 71.2%; P = .007) and statins (78.5% vs 69.8%; P < .0001). There were no differences in indications or types of LER. Perioperative complications were similar between male and female patients except for return to the operating room, which was higher in males (17.7% vs 13.9%; P = .029). After a mean follow-up of 3 years, there was no difference in major amputation, reintervention rate, MALE, or mortality. A total of 2647 reinterventions were performed. Female patients had significantly higher rate of ipsilateral reinterventions compared to males (2.0 ± 1.5 vs 1.7 ± 1.4; P = .05) and higher proportion of three or more reinterventions performed (9.5% vs 6.6%; P = .035) (Table). Kaplan-Meier curves showed no difference between males and females in MALE-free survival (Figure). Despite fewer comorbidities, female patients underwent a higher frequency of reinterventions than males to achieve similar outcomes of limb salvage and survival. The frequency of reinterventions can reveal differences in LER for PAD that are not apparent by traditional outcome measures.TableComparison of presentation, postoperative outcomes, and reintervention patterns between males and femalesMale (n = 1251; 63%)Female (n = 736; 37%)P valueDemographics Age, years69.2 ± 10.670.5 ± 12.4.015 Race.003White981 (78.8)535 (73.9)Black153 (12.3)130 (18.0)Other111 (8.9)59 (8.2) Body mass index28.1 ± 6.128.2 ± 7.2.694Comorbidities Coronary artery disease738 (59.3)334 (45.6)