Gender-specific Differences in Great Saphenous Vein Conduit. A Link to Lower Extremity Bypass Outcomes Disparities?
BACKGROUND
Inferior lower extremity bypass (LEB) outcomes have been reported among women with peripheral arterial disease (PAD), but the mechanisms responsible for this disparity are unknown. Great saphenous vein (GSV) is considered the conduit of choice for LEB; GSV diameter is associated with graft patency and therefore is often used as a criterion for suitability for use as bypass conduit. We hypothesized that gender-based differences in GSV may contribute to LEB outcomes disparities. To explore this hypothesis, we performed a gender-based analysis of GSV anatomic characteristics among patients with PAD who were studied with duplex ultrasound vein mapping during evaluation for LEB.


METHODS
Consecutive patients undergoing ultrasound vein mapping for planned LEB were analyzed. Minimum above- and below-knee GSV diameters were obtained in addition to demographic, procedural, and clinical data. Associations between gender and GSV diameter were evaluated using multivariate mixed models adjusting for anatomic location and within-patient correlation.


RESULTS
One hundred five patients were analyzed. Mean patient age was 65 ± 11 years, 25% were women, and 78% were white. Mixed model estimates of minimum GSV diameters were 3.14 ± 0.09 mm above knee and 2.74 ± 0.09 below knee for men versus 3.23 ± 0.14 above-knee and 2.49 ± 0.14 below knee for women. A gender-based interaction between anatomic location and GSV diameter was identified, with women having a greater difference between above- and below-knee GSV diameters (or taper; mean difference of 0.73 ± 0.12 vs. 0.41 ± 0.17 mm; P = 0.017).


CONCLUSIONS
GSV taper (difference between above- and below-knee diameters) is greater in women and may contribute to inferior patency after LEB with vein conduit, particularly for below-knee target vessels. Further research is necessary to evaluate specific hemodynamic effects of graft taper and links with other clinical endpoints. In addition to minimum diameter, vein graft taper may warrant consideration when planning LEB.
Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
Emily R
ER
Lagergren
Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
Kelly
K
Kempe
Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC.
Timothy E
TE
Craven
Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
S Tucker
ST
Kornegay
Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
Nitin
N
Garg
Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
Gabriela
G
Velazquez-Ramirez
Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
Justin B
JB
Hurie
Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
Matthew S
MS
Edwards
Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC. Electronic address: mcorrier@med.umich.edu.
Matthew A
MA
Corriere
D000368:Aged; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000637:transplantation*; D012737:Sex Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency