Limb-related Outcomes Are Poor In Young Patients After Infrainguinal Revascularization And Not Different Between Males And Females
Fang Yuan, MSc.1, Margaret C. Tracci, MD1, Carlin A. Williams, MD1, William Darrin Clouse, MD1, William P. Robinson, MD2.
1University of Virginia, Charlottesville, VA, USA, 2East Carolina University Brody School of Medicine, Greenville, NC, USA.
OBJECTIVES: The outcomes of infrainguinal revascularization are thought to be inferior in young females compared to young males but current results are poorly described. The objective of this study was to assess the impact of gender on the outcome of young patients undergoing infrainguinal revascularization, either endovascular intervention (ENDO) or bypass (OPEN).
METHODS: We compared male and female patients age ≤ 55 who underwent initial infrainguinal ENDO or OPEN for atherosclerotic occlusive disease at a single tertiary institution from 2011-2018. The primary outcomes were 30-day morbidity, long-term patency, and major adverse limb events (MALE: amputation and reintervention). Gender-specific outcomes of ENDO and OPEN were assessed. Follow-up was censored after the last date of documented vascular status.
RESULTS: 81 revascularizations were assessed including 45 infrainguinal index limb revascularizations in 37 males and 36 revascularizations in 31 females. ENDO was performed in 46 (56.8%) and OPEN in 35 (43.2%); the distribution did not differ between genders. Females were younger, had higher BMI, and higher rates of diabetes and hyperlipidemia than males. Indication for revascularization (65% CLTI, 35% claudication) did not differ by gender. Females experienced higher rates of wound complications (14% vs. 0%, P=0.02) and a lower postoperative increase in ABI (F: 0.2±0.2 vs. M: 0.4±0.2, P=0.04). At a mean follow up of 806 days, the patency of ENDO (primary patency: 30 ± 8 %, assisted patency 48 ±9%, secondary patency: 53 ± 9% at 1 year) and OPEN (primary patency: 39 ± 9 %, assisted patency 58 ± 9%, secondary patency: 72 ± 9% at 1 year) did not differ between genders. Among males, OPEN was associated with better secondary patency than ENDO. Among females, ENDO and OPEN patency was not significantly different. Kaplan-Meier 1-year rates of MALE (53 ± 6%), amputation (7 ± 3%), and reintervention (50 ± 6%) did not differ between genders.
CONCLUSIONS: Infrainguinal bypass has better patency than endovascular intervention in young male patients. Limb-related outcomes were poor in young patients undergoing infrainguinal revascularization and not different between males and females. These findings support a cautious stance toward elective revascularization in both young males and females and highlight the need for improved treatment strategies in young patients with infrainguinal occlusive disease.
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