title: The influence of gender on functional outcomes of lower extremity bypass.
abstract: OBJECTIVE
  Our aim was to evaluate the effect of gender on early and late procedural and functional outcomes of lower extremity bypass (LEB).
  
  
  METHODS
  We reviewed the records of 2576 patients (828 women; 32%) who underwent LEB for claudication or critical limb ischemia (CLI) in the Vascular Study Group of New England from 2003 to 2010. Logistic regression and proportional hazards models were used to adjust for potential confounding differences between genders. Morbidity, mortality, graft patency, freedom from major amputation, ambulation, and living status were analyzed postoperatively and over 1 year.
  
  
  RESULTS
  Women were older (70 vs 68 years; P < .001), had more hypertension (89% vs 85%; P = .006), less coronary artery disease (35% vs 39%; P = .03), smoking (73% vs 88%; P < .001), and preoperative statin use (60% vs 64%; P = .04). Women were more likely to have CLI (76% vs 71%; P = .003), and ambulate with assistance at presentation (19% vs 16%; P = .02). Morbidity was similar except women had higher rates of reoperation for thrombosis (4% vs 2%; P < .001) without differences in major amputation (2% vs 1%; P = .13) or in-hospital mortality (1.7% vs 1.7%; P = .96). Women and men with claudication had similar 1-year graft patency rates. Women with CLI had lower rates of primary (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.03-1.48; P = .02), assisted primary (HR, 1.42; 95% CI, 1.15-1.76; P = .001) and secondary patency (HR, 1.40; 95% CI, 1.10-1.77; P = .006) during the first year compared with men. Freedom from amputation was similar for men and women with CLI (HR, 1.17; 95% CI, 0.84-1.63; P = .36). There were no differences in late survival between women and men with claudication (HR, 0.89; 95% CI, 0.60-1.31; P = .36) or CLI (HR, 0.94; 95% CI, 0.81-1.09; P = .39). More female claudicants were not independently ambulatory at discharge (30% vs 19%; P = .002) and were discharged to a nursing home (15% vs 5%; P < .001) but these differences did not persist at 1 year. Women with CLI were more likely to be nonambulatory at discharge (13% vs 9%; P = .006) and at 1 year (13% vs 8%; P < .001). More women with CLI were discharged to a nursing home (44% vs 35%; P = .01) and resided there at 1 year (11% vs 7%; P = .02).
  
  
  CONCLUSIONS
  Women have complication rates similar to men with inferior early and late functional outcomes after LEB. The reduced patency rates in women with CLI did not translate into differences in limb salvage. These findings might help define physician and patient expectations for women before revascularization.
authors.affiliation: Division of Vascular Surgery, University of Vermont College of Medicine, Burlington, Vt.
authors.forename: Reshma P
authors.initials: RP
authors.lastname: Duffy
authors.affiliation: Division of Vascular Surgery, University of Vermont College of Medicine, Burlington, Vt.
authors.forename: Julie E
authors.initials: JE
authors.lastname: Adams
authors.affiliation: Division of Vascular Surgery, University of Vermont College of Medicine, Burlington, Vt.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Callas
authors.affiliation: Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass.
authors.forename: Andres
authors.initials: A
authors.lastname: Schanzer
authors.affiliation: Division of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodney
authors.affiliation: Division of Vascular Surgery, Central Maine Heart and Vascular Institute, Lewiston, Me.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Ricci
authors.affiliation: Division of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors.forename: Jack L
authors.initials: JL
authors.lastname: Cronenwett
authors.affiliation: Division of Vascular Surgery, University of Vermont College of Medicine, Burlington, Vt. Electronic address: daniel.bertges@vtmednet.org.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Bertges
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D015897:Comorbidity; D016638:Critical Illness; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009511:New England; D016017:Odds Ratio; D010351:Patient Discharge; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency