The impact of gender on the results of arterial bypass with in situ greater saphenous vein.
BACKGROUND
This 10-year review of in situ saphenous vein bypass surgery was undertaken to assess the impact of gender on infrainguinal arterial reconstruction.


METHODS
From March 1983 to March 1993, the results of 244 in situ saphenous vein bypasses performed in women were compared with 338 performed in men. Women were older than men (70.9 versus 66.8 years; P < 0.001) and had a higher incidence of hypertension but a lower incidence of coronary artery disease, smoking history, and chronic obstructive pulmonary disease. The primary indication for surgery was limb salvage for both genders (women 70.1%, men 68%; P = not significant [NS]). Men had bypasses to more-distal outflow vessels with 52.5% to the tibial level compared with 42.2% of women (P < 0.003).


RESULTS
Women had lower perioperative mortality rates than men (0.8% versus 3.3%; P < 0.025) and a similar incidence of major complications (6.6% versus 7.7%; P = NS), but a higher incidence of significant wound complications (13.5% versus 3.3%; P < 0.001). Life-table evaluation at 10 years after surgery showed no significant differences between women and men in primary graft patency rate (67.8% versus 58.2%; P = NS), secondary patency rate (73.5% versus 77.2%; P = NS ), limb salvage rate (87.9% versus 92%; P = NS) or patient survival rate (35.5% versus 24.4%; P = NS). For bypasses to the tibial arteries, graft patency rates were slightly inferior for women (69.8% versus 81.1%, 5-year secondary patency rate; P < 0.008). Similarly, in bypasses performed for limb salvage, women had lower 5-year primary patency rates than men (60.3% versus 70.3%; P < 0.002). Secondary patency rates in this limb salvage group however, did not differ (75.5% versus 82.8%; P = NS).


CONCLUSIONS
Despite small gender differences in the results of in situ bypass grafts for limb salvage and those carried to the tibial level, women had the same overall patency, limb salvage, and survival rates as men after infrainguinal bypass surgery. Treatment of infrainguinal occlusive disease should not vary based on inaccurate perceptions concerning differences in surgical results for men and women.
Belkin
M
M
Department of Surgery, Brigham and Womens' Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Conte
M S
MS
Donaldson
M C
MC
Mannick
J A
JA
Whittemore
A D
AD
D000368:Aged; D003327:Coronary Disease / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications; D007511:Ischemia / Q000401:mortality / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008173:Lung Diseases, Obstructive / Q000150:complications; D008297:Male; D011183:Postoperative Complications; D012501:Saphenous Vein / Q000601:surgery*; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome; D014654:Vascular Patency