title: Gender-related long-term outcome of primary femoropopliteal stent placement for peripheral artery disease.
abstract: OBJECTIVE
  To evaluate gender-related long-term outcomes in patients undergoing stent treatment of femoropopliteal peripheral artery disease.
  
  
  METHODS
  Between September 2006 and August 2010, all 517 patients (333 men and 184 women; mean age 70.6 years) undergoing primary stent placement in femoropopliteal atherosclerotic lesions at 2 European vascular centers were prospectively enrolled in the study. The main study outcome was primary stent patency. Secondary outcomes included secondary patency, limb salvage, and all-cause mortality.
  
  
  RESULTS
  Women had a higher incidence of critical limb ischemia (32.1% vs. 16.9%, p<0.001). Lesion characteristics according to the TransAtlantic Inter-Society Consensus (TASC) classification were comparable in both genders (p=0.52), although total occlusions and popliteal involvement were observed more frequently in female patients (p=0.043 and p=0.001, respectively). Both genders showed similar 5-year primary patency rates (64.3% men vs. 58.1% women, p=0.11). A statistically significant difference was observed concerning the secondary patency rates in favor of men (71.9% vs. 66.8% at 5 years, p=0.005). Limb salvage rates did not vary between the groups (p=0.83). Survival rates were comparable at 5 years (83.3% and 82.6% for men and women, respectively; p=0.63), although female patients were older at their presentation (68.5 vs. 74.3 years, p<0.001). Female gender was an independent risk factor for restenosis for TASC C/D lesions (primary patency rate 39.8% in women vs. 62.0% in men; p=0.002). Finally, critical limb ischemia was an independent risk factor for restenosis in women (odds ratio 1.5).
  
  
  CONCLUSIONS
  Female gender was associated with a higher prevalence of critical limb ischemia, poorer secondary patency, and more frequent restenosis in TASC C/D lesions. Endovascular treatment of femoropopliteal lesions provides equal results between genders in terms of primary stent patency in the long term.
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster, and Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany stavroulakis.konstantinos@yahoo.gr.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Stavroulakis
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster, and Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany.
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Donas
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster, and Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Torsello
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster, and Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany.
authors.forename: Nani
authors.initials: N
authors.lastname: Osada
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster, and Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Schönefeld
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005062:European Union; D005260:Female; D005263:Femoral Artery / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011150:Popliteal Artery / Q000473:pathology; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D015607:Stents; D016896:Treatment Outcome
keywords: balloon angioplasty; gender; occlusion; patency; peripheral artery disease; popliteal artery; primary stenting; restenosis; stenosis; stent; superficial femoral artery