Association of sex with patency of femorodistal bypass grafts.
OBJECTIVE
There is evidence for superior patency in infra-inguinal bypass procedures in men compared to women. A large, prospectively planned series was investigated in order to confirm this finding and to determine the origin of this difference in outcome.


METHODS
Patients underwent femorodistal bypass surgery and a prospectively planned 12-month follow-up. Outcomes in male and female patients were compared and investigated for associations with characteristics of the patients and the surgical procedures.


RESULTS
A total of 517 patients received femorodistal bypass grafts, including 424 vein grafts and 93 prosthetic and vein-prosthetic composite grafts. Patency was confirmed to be higher in male than in female patients (56% vs. 42%, p=0.005). Fewer male patients received prosthetic or composite grafts (21% vs. 33%, p=0.005), but the difference in patency was evident only in patients receiving vein grafts. Female patients were smaller, included fewer smokers (p<0.001) and had worse symptoms (p=0.03), but none of these characteristics explained the difference in outcome. Patency in vein grafts was associated with graft diameter (p=0.004), but graft diameter was not significantly associated with sex (p=0.09) or with body size.


CONCLUSIONS
It was confirmed that patency of femorodistal bypasses is significantly higher in males than females. None of the factors investigated here explain this difference, but the greater use of prosthetic and composite grafts in female patients suggests that poorer vein quality should be investigated as a possible source of the inferior outcome in female patients.
Watson
H R
HR
School of Postgraduate Medicine, University of Bath, U.K.
Schroeder
T V
TV
Simms
M H
MH
Horrocks
M
M
D000368:Aged; D000671:Amputation, Surgical; D001158:Arteries / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D015992:Body Mass Index; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology*; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D011446:Prospective Studies; D012086:Reoperation; D012737:Sex Factors; D014680:Veins / Q000637:transplantation