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Gender Differences In Tibial Artery Intervention For Critical Limb Ischemia (CLI): A Retrospective Study Using The Vascular Quality Initiative (VQI)
Amey Vrudhula, B.S.E., Ajit Rao, M.D., Windsor Ting, M.D., Ageliki Vouyouka, M.D., Rami Tadros, M.D., Daniel Han, M.D., Sung Yup Kim, M.D., Michael Marin, M.D., Peter Faries, M.D..
Icahn School of Medicine at Mt. Sinai, New York, NY, USA.

OBJECTIVE - Limited and often conflicting data exist on gender differences in outcomes in the treatment of critical limb ischemia (CLI). This study was conducted to shed light on gender differences in outcomes in patients with CLI receiving intervention in tibial vessels.
METHODS - The VQI Peripheral Vascular Intervention (PVI) dataset was filtered for procedures treating tibial occlusive lesions in patients with CLI. When a patient underwent multiple procedures, all procedures were included, and data from all years available was used. All procedures, excluding one procedure, were from 2010-2020. All analyses were conducted using SPSS 20 (IBM, Armonk NY). Chi-square analysis was used to compare categorical variables. Nominal variables were assessed for normality using a Kolmogorov-Smirnov Test, and a Mann-Whitney U-Test was used when normality was not met.
RESULTS - The average age of males and females was 68 and 70 (p=0.000), respectively. Overall rates of comorbidities were similar between the two groups although male patients were more likely to have diabetes, chronic kidney disease, and coronary artery disease. Female patients were more likely to have had prior stroke and COPD. Females and males undergoing tibial CLI intervention experienced similar rates of major amputations. Female patients had overall lower amputation rates (30.6% vs. 35.3 %, p = .002, χ2 = 9.314) but experienced a higher rate of other postoperative complications (10.4% vs. 7.3%, p=0.000, χ2 = 21.279) and access site complications (2.7% vs. 1.9%, p = .017, χ2 =5.670). These complications included hematoma, renal complication, thrombosis, and perforation rates. Men were more likely to have more than one artery treated, but total occlusion length did not significantly differ between groups.
CONCLUSIONS: Our study shows that males and females have similar rates of limb salvage for infrageniculate interventions but females experience higher rates of postoperative complications. Further studies are required to further elucidate gender differences in tibial CLI intervention and identify high-risk groups undergoing tibial intervention.
Table 1 - Gender Differences in Tibial Intervention for CLI

MaleFemaleAll PatientsP-Value
AGE68 (60-77)
(N=10,308)
70 (62-80)
(N=3669)
69 (61-78)
(N=13977)
0.000*
Ethnicity - Hispanic or Latino?No90.14% (9275)89.92% (3293)90.08% (12568).712
Yes9.86% (1015)10.08% (369)9.92% (1384)
Pre ASA (Aspirin)No31.49% (3245)36.31% (1332)32.76% (4577).000*
Yes68.51% (7060)63.69% (2336)67.24% (9396)
Pre StatinNo29.01% (2989)35.07% (1286)30.6% (4275).000*
Yes70.99% (7314)64.93% (2381)69.4% (9695)
Pre Chronic AnticoagulantNo75.08% (7734)77.28% (2834)75.66% (10568).008*
Yes24.92% (2567)22.72% (833)24.34% (3400)
HypertensionNo9.1% (937)9.8% (359)9.3% (1296).212
Yes90.9% (9359)90.2% (3305)90.7% (12664)
DiabetesNo18.4% (1892)29.8% (1092)21.4% (2984).000*
Yes81.6% (8412)70.2% (2575)78.6% (10987)
CreatinineNormal Creatinine (<1.2 mg/dL)53.8% (4295)67.5% (1961)57.5% (6256).000*
Abnormal Creatinine (>=1.2 mg/dL)46.2% (3687)32.5% (944)42.5% (4631)
DialysisNo75.2% (7743)77.4% (2839)75.7% (10582).006*
Yes (or functioning Transplant)24.8% (2560)22.6% (828)24.3% (3388)
Coronary Artery Disease (CAD)No65.5% (6744)70.6% (2587)66.8% (9331).000*
Yes34.5% (3555)29.4% (1077)33.2% (4632)
Smoking StatusNever42.2% (4343)58.4% (2139)46.4% (6482).000*
Prior or Current57.8% (5950)41.6% (1524)53.6% (7474)
COPDNo83.1% (8559)80.4% (2950)82.4% (11509).000*
Yes16.9% (1742)19.6% (717)17.6% (2459)
Prior StrokeNo82.7% (5448)80.3% (1769)82.1% (7217).009*
Yes17.3% (1138)19.7% (435)17.9% (1573)
Tissue Loss Severity LeftGrade 1, shallow58.5% (1872)61.9% (599)59.3% (2471).084
Grade 2, deep34.2% (1094)32.4% (314)33.8% (1408)
Grade 3, extensive7.3% (234)5.7% (55)6.9% (289)
Tissue Loss Severity RightGrade 1, shallow58.1% (1906)60.9% (616)58.7% (2522).075
Grade 2, deep34.6% (1135)33.7% (341)34.4% (1476)
Grade 3, extensive7.3% (240)5.4% (55)6.9% (295)
Total Occlusion Length (cm)9.18 (17.07)9.04 (17.37)9.14 (17.15).996
Number of Arteries Treated175.6% (7789)79% (2898)76.5% (10687).000*
2, 3, or 424.4% (2519)21.0% (771)23.5% (3290)
Total Treated Length (cm)17.14 (19.16)16.39 (18.64)16.94 (19.03).015 *
Amputation During AdmissionNo64.7% (2467)69.4% (856)65.8% (3323).002*
Yes35.3% (1347)30.6% (377)34.2% (1724)
Planned AmputationNo22.1% (299)21.6% (82)22% (381).837
Yes77.9% (1052)78.4% (297)78% (1349)
Amputation Level - RightMinor Amputation (Toe(s) or Trans-foot)83.4% (625)79.5% (163)82.6% (788).188
Major Amputation (Above Foot)16.6% (124)20.5% (42)17.4% (166)
Amputation Level - LeftMinor Amputation (Toe(s) or Trans-foot)83.8% (528)81.6% (146)83.3% (674).477
Major Amputation (Above Foot)16.2% (102)18.4% (33)16.7% (135)
Post-Procedure ComplicationsNo92.7% (6104)89.6% (1975)91.9% (8079).000*
Yes7.3% (483)10.4% (230)8.1% (713)
Cardiac ComplicationsNo98.3% (6477)98.3% (2168)98.3% (8645).983
Yes1.7% (111)1.7% (37)1.7% (148)
Renal ComplicationsNo98.9% (6516)98.1% (2163)98.7% (8679).004*
Yes1.1% (72)1.9% (42)1.3% (114)
ThrombosisNo99.7% (6564)99% (2184)99.5% (8748).000*
Yes0.3% (22)1% (21)0.5% (43)
PerforationNo99.3% (6543)98.7% (2177)99.2% (8720).005*
Yes0.7% (43)1.3% (28)0.8% (71)
Access Site ComplicationsNo98.1% (6463)97.3% (2145)97.9% (8608).017*
Yes1.9% (124)2.7% (60)2.1% (184)
Hematoma or BleedingNo98.2% (9141)97.1% (3288)97.9% (12429).000*
Yes1.8% (165)2.9% (99)2.1% (264)

* Statistically significant (α =0.05); Mann-Whitney U-Test Conducted


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