title: The impact of gender on outcome after infrainguinal arterial reconstructions for peripheral occlusive disease.
abstract: OBJECTIVE
  The role of gender on the outcome of infrainguinal arterial revascularization (IAR) for peripheral arterial occlusive disease remains uncertain. This study analyzed the outcome of IARs performed over 15 years, stratifying the results by sex.
  
  
  METHODS
  Details of consecutive patients undergoing primary IAR for peripheral arterial occlusive disease from 1995 to 2009 at our institution were prospectively stored in a vascular registry. Demographics, risk factors, indications for surgery, inflow sources, outflow target vessels, types of conduit, and adverse outcomes were analyzed. Postoperative surveillance included clinical examination supplemented with duplex scans and ankle-brachial index measurements in all patients at discharge, 30 days, 6 months, and every 6 months thereafter. End points of the study, ie, patency, limb salvage, and survival rates, were assessed using Kaplan-Meier life-table analysis. The χ(2) or Fisher exact, Student t, and log-rank tests were used to establish statistical significance.
  
  
  RESULTS
  Our sample consisted of 1459 IARs performed in 1333 patients, comprising 496 women (37.2%; 531 IARs), who were a mean 3 years older than the men (74 vs 71 years; P < .001) and had a higher incidence of diabetes mellitus (52% vs 46%; P = .03) and surgery for limb salvage (91% vs 87%; P = .02). An autogenous vein conduit (great or small saphenous, or both, spliced, arm, or composite veins) was used in 87% of the IARs. No deaths occurred perioperatively (30 days). The major and minor complication rates were comparable between men and women. At 10 years, the primary patency rate was 47% in women vs 49% in men (P = .67), the assisted primary patency rate was, respectively, 53% vs 50% (P = .69), the secondary patency rate was 61% vs 61% (P = .66), limb salvage rate was 93% vs 91% (P = .54), and survival rate was 43% vs 49% (P = .65). Stratifying by type of conduit revealed no differences in patency or limb salvage rates.
  
  
  CONCLUSIONS
  Despite an older age and more advanced stages of disease on presentation in women, IAR performed in women can achieve patency and limb salvage rates statistically no different from those recorded in their male counterparts, supporting the conviction that sex per se does not influence the outcome of lower extremity revascularization.
authors.affiliation: Vascular Surgery Section, Geriatric Surgery Clinic, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy. enzo.ballotta@unipd.it
authors.forename: Enzo
authors.initials: E
authors.lastname: Ballotta
authors.forename: Mario
authors.initials: M
authors.lastname: Gruppo
authors.forename: Renata
authors.initials: R
authors.lastname: Lorenzetti
authors.forename: Giacomo
authors.initials: G
authors.lastname: Piatto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: DaGiau
authors.forename: Antonio
authors.initials: A
authors.lastname: Toniato
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007264:Inguinal Canal / Q000098:blood supply*; D015993:Life Tables; D023821:Limb Salvage; D008297:Male; D019651:Plastic Surgery Procedures; D012737:Sex Factors; D016896:Treatment Outcome; D014654:Vascular Patency