Intermittent claudication (IC) is a commonly treated vascular condition. Patient sex
has been shown to influence outcomes of interventions for other vascular disorders;
however, whether outcomes of interventions for IC vary by sex is unclear. We sought
to assess the association of patient sex with outcomes after IC interventions.
The Vascular Quality Initiative was queried from 2010–2020 for all peripheral endovascular
interventions (PVI), infra-inguinal bypasses (IIB), and supra-inguinal bypasses (SIB)
for any degree IC. Univariable and multivariable analyses compared peri-operative
and long-term outcomes by patient sex.
There were 24,701 female and 40,051 male patients undergoing PVI, 2,789 female and
6,525 male patients undergoing IIB, and 1,695 female and 2,370 male patients undergoing
SIB for IC. Guideline-recommended pre-operative medical therapy differed with female
patients less often prescribed aspirin for PVI (73.4% vs. 77.3%), IIB (71.5% vs. 74.8%),
and SIB (70.9% vs. 74.3%) or statins for PVI (71.8% vs. 76.7%) and IIB (73.1% vs.
76.0%) (all P < 0.05). Female compared with male patients had lower 1-year reintervention-free
survival after PVI (84.4% ± 0.3% vs. 86.3% ± 0.2%, P < 0.001), IIB (79.0% ± 0.9% vs. 81.2% ± 0.6%, P = 0.04), and SIB (89.4% ± 0.9% vs. 92.6% ± 0.7%, P = 0.005), but similar amputation-free survival and survival across all procedures.
Multivariable analysis confirmed that female sex was associated with increased 1-year
reintervention for PVI (HR 1.16, 95% CI 1.09–1.24, P < 0.001), IIB, (HR 1.16, 95% CI 1.03–1.31, P = 0.02), and SIB (HR 1.60, 95% CI 1.20–2.13, P = 0.001).
Female patients undergoing interventions for IC were less often pre-operatively medically
optimized than male patients, though the difference was small. Furthermore, female
sex was associated with more reinterventions after interventions. Interventionists
treating female patients should increase their efforts to maximize medical therapy.
Future research should clarify reasons for poorer intervention durability in female