title: Impact of sex on morbidity and mortality rates after lower extremity interventions for peripheral arterial disease: observations from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium.
abstract: OBJECTIVE
  This study sought to examine sex-related differences in outcomes related to peripheral vascular intervention (PVI) procedures.
  
  
  BACKGROUND
  Percutaneous PVI is frequently performed for the treatment of peripheral arterial disease (PAD). However, little is known about sex-related differences related to PVI procedures.
  
  
  METHODS
  We assessed the impact of sex among 12,379 patients (41% female) who underwent lower extremity (LE)-PVI from 2004 to 2009 at 16 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PVI registry. Multivariate propensity-matched analyses were performed to adjust for differences in baseline characteristics, procedural indications, and comorbidities on the basis of sex.
  
  
  RESULTS
  Compared with men, women were older and have multilevel disease and critical limb ischemia. In a propensity-matched analysis, female sex was associated with a higher rate of vascular complications, transfusions, and embolism. No differences were observed for in-hospital death, myocardial infarction, or stroke or transient ischemic attack. Technical success was more commonly achieved in women (91.2% vs. 89.1%, p = 0.014), but because of a higher complication rate, the overall procedural success rates were similar in men and women (79.7% vs. 81.6%, p = 0.08).
  
  
  CONCLUSIONS
  Women represent a significant proportion of patients undergoing LE-PVI, have a more severe and complex disease process, and are at increased risk for adverse outcomes. Despite higher complications rates, women had similar procedural success compared with men, making PVI an effective treatment strategy among women with LE-PAD.
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Jackson
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Khan
authors.initials: K
authors.lastname: Munir
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, Detroit Medical Center and Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Theodore
authors.initials: T
authors.lastname: Schreiber
authors.affiliation: Department of Vascular Surgery, Detroit Medical Center and Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Rubin
authors.affiliation: Division of Vascular Surgery, Spectrum Health Medical Group, Grand Rapids, Michigan.
authors.forename: Robert
authors.initials: R
authors.lastname: Cuff
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Gallagher
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Henke
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, Michigan. Electronic address: pagross@umich.edu.
authors.forename: P Michael
authors.initials: PM
authors.lastname: Grossman
mesh_terms: D000368:Aged; D054598:Blue Cross Blue Shield Insurance Plans / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008824:Michigan / Q000453:epidemiology; D009017:Morbidity / Q000639:trends; D058729:Peripheral Arterial Disease / Q000401:mortality* / Q000601:surgery*; D011183:Postoperative Complications; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D017678:Sex Distribution; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D014656:Vascular Surgical Procedures / Q000401:mortality*
keywords: peripheral arterial intervention; peripheral vascular disease; sex