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Peripheral Artery Disease In Black Women: A Single Institution Experience
Molly Ratner, MD, Moira McGevna, Bhama Ramkhelawon, PhD, Karan Garg, MD, Mikel Sadek, MD, Thomas Maldonado, MD, Glenn Jacobowitz, MD, Caron Rockman, MD.
New York University Langone Hospital, New York, NY, USA.

OBJECTIVES: Black patients with peripheral artery disease (PAD) experience worse outcomes, however; is a paucity of literature examining outcomes in black women, specifically. The aim of this study is to examine the outcomes in black women who underwent an endovascular first approach. METHODS: The Institutional Vascular Quality Initiative was queried between (2013-2022). Preoperative risk factors, perioperative morbidity/mortality (including major adverse cardiac events [MACE]), and late outcomes (including major adverse limb events [MALE]) were collected. Time
RESULTS: The mean age of the 161 included patients was 67.5 +/- 13.4 years. The most frequently observed comorbidities included hypertension (88.2%), hyperlipidemia (70.3%), diabetes (62.1%), smoking history (54.7%) coronary artery disease (24.8%) and end-stage renal disease (16.8%). Forty-seven patients (30.1%) had undergone peripheral intervention and 22 (13.7%) had an amputation. Preoperatively, 57.1% were on aspirin and 66.5% were on a statin. At baseline, the mean ankle-brachial index (ABI) for the affected limb was 0.73 +/- 0.3. The most frequent indications for intervention were chronic limb threatening ischemia (58.4%) and claudication (27.3%). The most frequently treated arteries were the superficial femoral (27%) and anterior tibial (16%) arteries. Technical success in the index operation was achieved in 93.4% of cases, although 6.1% re-thrombosed within 30 days. In a subgroup analysis, younger patients (age ≤ 55) were more likely to experience an embolic event (4% vs 0%, p = .03). The rate of perioperative MACE for all was 1.9%. The median follow-up was 374 days, and the mean change in ABI was .06 +/- .27. Sixty-four patients (39.8%) required ipsilateral reintervention, most frequently for tissue loss (19.3%), with a median time to reintervention of 145 days. The rate of MALE was (10%) with a median time to amputation of 71 days.
CONCLUSIONS: In this institutional review black women with PAD, patients had high rates of known atherosclerotic risk factors, despite many not receiving appropriate primary prevention. Patients tended to present with late-stage disease (i.e. CLTI). Although technical success rate was high, over one-third of patients required re-intervention and 10% of patients experienced a major adverse limb event, most within a year. Our findings reinforce the importance of aggressive primary prevention and improved early access to care.
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