Back to Annual Symposium Program

OBJECTIVE: Prior studies have suggested treatment and outcome disparities between men and women for lower extremity peripheral arterial disease (PAD). Given the recent shift towards endovascular therapy, we sought to analyze gender disparities in interventions, amputations, and inpatient mortality based on presentation (limb threat vs. claudication).
METHODS: We identified patients with lower extremity arterial occlusive disease, subdivided into intermittent claudication (IC) vs. limb threat (LT) using ICD-9 codes in the Nationwide Inpatient Sample (NIS) from1995 to 2009. We compared open surgery (endarterectomy, aortibifemoral bypass, peripheral bypass) to PTA ± stent (PTA/S). Results were indexed to the population using U.S. Census Bureau data.
RESULTS: We identified 343,237 patients (56.9% male) who underwent treatment, 62.9% for LT. Women were older by 2.6 years on average and more likely to present with LT (Figure, p<0.05 for all years). Women were more likely to receive PTA/S for both IC and LT (p<0.05). Women had higher rates of major amputation prior to 2000, similar rates from 2000-2005 and lower rates after 2005. After an initial steady climb from 1995-2006, we observed a drop in the rate of endovascular revascularization after 2007 for both IC and LT while rates of bypass remained stable. Overall amputation rates continue to decline despite the recent decline in PTA/S. Over the study period, women had higher in-hospital mortality for both IC (PTA/S 0.6% vs. 0.3%, p <0.0001, Surgery 1.2% vs. 0.8%, p<0.0001) and CLI (PTA/S 3.6% vs. 3.0%, p<0.0001, Surgery 3.8% vs. 3.2%, p<0,0001).
CONCLUSIONS: Women with PAD appear to present at a later stage, are more likely to be treated with PTA/S, and have higher in-hospital mortality. Surprisingly, amputation rates among women are now similar/lower than for men. Enthusiasm for PTA/S appears to be declining. Despite this, amputation rates continue to decline.