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Ghoddusi Johari H, Farrokhi A, Shahriarirad R, Hosseinzadeh A, Hodjati H. Analysis of a Large 19-Year Database in Vascular Surgery in Southern Iran: Evaluation of Trends and Limitations. Ann Vasc Surg 2024; 102:74-83. [PMID: 38309425 DOI: 10.1016/j.avsg.2023.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Large databases with data elements of clinical interest are essential for carrying out high-quality observational studies. Such databases have become increasingly popular for clinical research in fields like vascular surgery. Our goal is to create a solid and reliable database of the patients who have been admitted and undergone different vascular surgery procedures over 19 years and to provide surgeons with the current trends and limitations in managing patients with vascular disease. METHODS The database of patients operated in Namazi Hospital, the referral center for vascular surgery in Southern Iran, from 2001 to 2019, was retrieved and patients undergoing vascular procedures were parted. Demographic and perioperative data were evaluated and patients were categorized into subgroups based on the type and cause of operation. All data were analyzed with SPSS version 26.0 (IBM, NY, USA). RESULTS During the period of our study, a total of 226,051 operations were performed at the Namazi Hospital. Among these operations, 6,386 (2.82%) vascular surgery-related operations were entered into our study. The average age of the patients in our study was 53.22 ± 18.92 years (range: 1 day old-97 years) and 4,061 (63.6%) were male. Furthermore, 147 (2.3%) were operated by multiple surgeons. Moreover, 798 (12.5%) of the patients were admitted postoperatively to the intensive care unit, while the rest (5,588; 87.5%) in the common surgery ward. The cause of operation in 609 (9.5%) of the cases was trauma. Based on wound categorization, 5,132 (80.4%) were type I (clean). The most frequent operation performed in our center was arterial reconstruction and limb revascularization (31.4%), followed by hemodialysis access (31.3%). The most frequent surgery in the age group of less than 18 years was fasciotomy, in the 19-40 years group was tumor (56.8%) and varicose veins (52.9%), and in the 41-60 years group was implantation of ventral venous port catheter (47%). Only carotid and thoracic outlet syndrome surgeries were significantly higher in females. The remaining operations were all significantly higher among male patients. Finally, carotid body tumor surgery was the most frequent operation requiring intensive care unit monitoring. CONCLUSIONS We demonstrated, for the first time, an overview of vascular surgeries performed in a referral tertiary center in Southwest Iran. There is an increase in the number of surgical procedures in the field of vascular surgery, and large databases will be a valuable tool for addressing critical problems in this field and also the healthcare system.
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Affiliation(s)
- Hamed Ghoddusi Johari
- Vascular Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran; Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirmohammad Farrokhi
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ahmad Hosseinzadeh
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Hodjati
- Vascular Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Ho-Yan Lee M, Li PY, Li B, Shakespeare A, Samarasinghe Y, Feridooni T, Cuen-Ojeda C, Alshabanah L, Kishibe T, Al-Omran M. A systematic review and meta-analysis of sex- and gender-based differences in presentation severity and outcomes in adults undergoing major vascular surgery. J Vasc Surg 2022; 76:581-594.e25. [DOI: 10.1016/j.jvs.2022.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/24/2022] [Indexed: 11/25/2022]
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3
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Soares Ferreira R, Bastos Gonçalves F. Extra Caution Required in Elective Abdominal Aortic Aneurysm Repair for Women. Eur J Vasc Endovasc Surg 2021; 62:379. [PMID: 34244094 DOI: 10.1016/j.ejvs.2021.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Rita Soares Ferreira
- Centro Hospitalar Universitário de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal; NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Frederico Bastos Gonçalves
- Centro Hospitalar Universitário de Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal; NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.
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Pasqui E, de Donato G, Alba G, Brancaccio B, Panzano C, Cappelli A, Setacci C, Palasciano G. Early and Long-Term Outcomes of Carotid Stenting and Carotid Endarterectomy in Women. Front Surg 2021; 8:646204. [PMID: 33763447 PMCID: PMC7982589 DOI: 10.3389/fsurg.2021.646204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The role of carotid revascularization in women remains intensely debated because of the lower benefit and higher perioperative risks concerning the male counterpart. Carotid artery endarterectomy (CEA) and stenting (CAS) represent the two most valuable stroke prevention techniques due to large vessel disease. This study investigates the early and late outcomes in female sex in a real-world everyday clinical practice. Methods: Data were retrospectively analyzed from a single-center database prospectively compiled. A total of 234 procedures, both symptomatic and asymptomatic, were identified (98 CEAs and 136 CASs). Perioperative risks of death, cerebral ischemic events, and local complications were analyzed and compared between the two groups. Long-term outcomes were evaluated in overall survival, freedom from ipsilateral stroke/transient ischemic attack, and freedom from restenosis (>50%) and reintervention. Results: Women who underwent CAS and CEA did not differ in perioperative ischemic cerebral events (2.2 vs. 0%, p = 0.26) and death (0.8 vs. 0%, p = 1). Other perioperative and 30-day outcomes were similarly distributed within the two groups. Kaplan–Meier curves between CAS and CEA groups highlighted no statistical differences at 6 years in overall survival (77.4 vs. 77.1%, p = 0.47) of ipsilateral stroke/transient ischemic attack (94.1 vs. 92.9%, p = 0.9). Conversely, significant differences were showed in 6 years freedom from restenosis (93.1 vs. 83.3%, p = 0.03) and reinterventions (97.7 vs. 87.8%, p = 0.015). Conclusion: Our results revealed that both CEA and CAS have acceptable perioperative risk in women. Long-term outcomes highlighted favorable indications for both procedures, especially for CAS, which seemed to be an excellent alternative to CEA in female patients when performed by well-trained operators.
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Affiliation(s)
- Edoardo Pasqui
- Vascular Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Gianmarco de Donato
- Vascular Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Giuseppe Alba
- Vascular Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Brenda Brancaccio
- Vascular Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Claudia Panzano
- Vascular Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Alessandro Cappelli
- Vascular Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Carlo Setacci
- Vascular Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Giancarlo Palasciano
- Vascular Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
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Parvar SL, Thiyagarajah A, Nerlekar N, King P, Nicholls SJ. A systematic review and meta-analysis of gender differences in long-term mortality and cardiovascular events in peripheral artery disease. J Vasc Surg 2020; 73:1456-1465.e7. [PMID: 33161072 DOI: 10.1016/j.jvs.2020.09.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Individual studies of peripheral artery disease (PAD) have indicated that gender discrepancies exist in the symptoms, functional status, and treatment usage. It remains uncertain whether these discrepancies result in different long-term outcomes. We examined the potential gender differences in mortality and major adverse cardiovascular events (MACE) in patients with symptomatic PAD. METHODS The PubMed and Embase databases were searched for studies from 2000 to January 2019. After a review of 13,582 citations, 14 articles were analyzed. The reported age-adjusted hazard ratios (HRs) for gender differences in mortality and MACE were included in the meta-analysis. The mortality outcomes were stratified according to the clinical presentation and study context. RESULTS Male gender was associated with a greater risk of all-cause mortality (HR, 1.13; 95% confidence interval [CI], 1.10-1.16; P < .001) and MACE (HR, 1.10; 95% CI, 1.06-1.14; P < .001). In a stratified analysis, male gender was associated with a higher mortality risk for patients presenting with either critical limb ischemia (HR, 1.08; 95% CI, 1.05-1.10; P < .001) or mixed clinical presentations (HR, 1.16; 95% CI, 1.11-1.21; P < .001) but not for those with intermittent claudication (HR, 1.13; 95% CI, 0.98-1.30; P = .09). Elevated mortality risk was evident after revascularization (HR, 1.11; 95% CI, 1.04-1.19; P = .003), hospitalization (HR, 1.15; 95% CI, 1.08-1.22; P < .001), and amputation (HR, 1.09; 95% CI, 1.08-1.10; P < .001), although not in outpatient clinics (HR, 1.13; 95% CI, 0.97-1.32; P = .13), in men compared with women. CONCLUSIONS Greater mortality and MACE rates in men with PAD occurred despite other accepted gender disparities. The mechanisms underlying these gender differences in the outcomes for PAD patients require further investigation.
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Affiliation(s)
- Saman L Parvar
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia.
| | - Anand Thiyagarajah
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Peta King
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Victoria, Australia
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Wang J, He Y, Shu C, Zhao J, Dubois L. The effect of gender on outcomes after lower extremity revascularization. J Vasc Surg 2017; 65:889-906.e4. [DOI: 10.1016/j.jvs.2016.11.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 11/10/2016] [Indexed: 01/24/2023]
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La mujer y la enfermedad vascular: características específicas. ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2015.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Vrijenhoek JEP, Haitjema S, de Borst GJ, de Vries JPPM, Vaartjes I, Moll FL, Pasterkamp G, den Ruijter HM. The impact of female sex on long-term survival of patients with severe atherosclerosis undergoing endarterectomy. Atherosclerosis 2014; 237:521-7. [PMID: 25463084 DOI: 10.1016/j.atherosclerosis.2014.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/15/2014] [Accepted: 10/02/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Long-term age- and sex-specific mortality data in patients undergoing carotid endarterectomy (CEA) and iliac/femoral endarterectomy (FEA) are scarce. We examined long-term mortality in these patient groups, stratified by age and sex. METHODS Between 2002 and 2012, 1771 patients (1200 men, 571 women) treated by CEA, and 685 patients (495 men, 190 women) who underwent FEA, were included and linked to the national mortality registry of the Netherlands. Absolute mortality risks during follow-up were analyzed by life-table and Kaplan Meier survival analyses in two age groups and stratified by sex, and compared to a matched sample from the general population. In addition, multivariable Cox regression analyses were performed. RESULTS After CEA, with a median follow-up duration of 4.3 years (interquartile range 2.0-7.1), 298 all-cause deaths had occurred in men (25%) and 105 (18%) in women. As in the general population, cumulative survival after CEA was significantly better in women compared to men (P = 0.002) and absolute CEA-associated mortality risk in women was similar to that of the general population. For FEA patients, mortality risk was worse than for CEA patients and the general population in both sexes and surprisingly, female sex did not have a favorable effect on survival. Following FEA, 130 men (26%) and 51 women (27%) died after a median follow-up time of 3.0 years (interquartile range 1.5-5.9). Stratifying by age, and adjusting for cardiovascular risk factors did not change these trends. CONCLUSIONS Long-term mortality after CEA is higher in men than in women, and in women mortality risk is similar to the general population. After FEA, the benefit of women as seen after CEA is lost.
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Affiliation(s)
- Joyce E P Vrijenhoek
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Saskia Haitjema
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gert Jan de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Ilonca Vaartjes
- Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerard Pasterkamp
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hester M den Ruijter
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
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Kuy S, Dua A, Desai SS, Rossi PJ, Seabrook GR, Lewis BD, Patel B, Kuy S, Lee CJ, Subbarayan R, Brown KR. Carotid endarterectomy national trends over a decade: does sex matter? Ann Vasc Surg 2013; 28:887-92. [PMID: 24321266 DOI: 10.1016/j.avsg.2013.08.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/07/2013] [Accepted: 08/12/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND The objective was to evaluate the difference in timing (if any) of in-hospital carotid endarterectomy (CEA) or outcomes of CEA based on sex among men and women hospitalized for carotid artery disease. METHODS This was a retrospective cross-sectional study using the Nationwide Inpatient Sample Database. All patients from 2000-2009 who underwent CEA during their hospitalization were examined. International Classification of Diseases, 9th revision codes were used to identify patients who underwent CEA during hospitalization, stratify asymptomatic and symptomatic patients, determine time in days from admission to CEA, and examine in-hospital complications, including perioperative stroke, cardiac events, and death. Statistical analysis was performed with chi-squared and t-tests. Linear and logistic regression models were used to evaluate relationships between sex and outcomes. The main outcome measures were time from admission to surgery, in-hospital mortality, complications, mean duration of stay, and discharge disposition. RESULTS Two hundred twenty-one thousand two hundred fifty three patients underwent CEA during hospitalization. More than 9% (9.2%) had symptomatic carotid artery disease. Among symptomatic patients, bivariate analysis found that women had a longer mean time from admission to surgery (2.8 vs. 2.6 days; P < 0.001) and a longer duration of hospital stay (6.4 vs. 5.9 days; P < 0.001) than their male counterparts. However, there was no difference between men and women with regard to rates of perioperative stroke, cardiac complications, myocardial infarction, or death. Among asymptomatic patients, women had a longer mean time from admission to surgery (0.53 vs. 0.48 days; P < 0.001) and a trend toward increased perioperative stroke (0.6% vs. 0.5%; P = 0.06), but a lower rate of cardiac complications (1.5% vs. 1.7%; P = 0.01) and in-hospital mortality (0.26% vs. 0.31%; P = 0.05). However, on multivariable analysis adjusting for differences in age, elective status, insurance, race, hospital location, hospital region, and hospital teaching status, there was no sex disparity in time from admission to surgery, regardless of symptomatic status. In addition, asymptomatic women were less likely than men to have a cardiac complication (odds ratio [OR]: 0.90; 95% confidence interval [CI]: 0.83-0.97) or in-hospital mortality (OR: 0.83; 95% CI: 0.70-0.98). Symptomatic women were also less likely than men to have a cardiac complication (OR: 0.78; 95% CI: 0.63-0.97). CONCLUSIONS In this decade-long national population-based study of hospitalized patients undergoing CEA, women had lower perioperative cardiac morbidity and mortality rates than men. After adjusting for patient, clinical, and hospital factors, there is no discernible difference in timing of CEA based on sex.
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Affiliation(s)
- Sreyram Kuy
- Division of Vascular Surgery at Medical College of Wisconsin, Milwaukee, WI.
| | - Anahita Dua
- Division of Vascular Surgery at Medical College of Wisconsin, Milwaukee, WI
| | | | - Peter J Rossi
- Division of Vascular Surgery at Medical College of Wisconsin, Milwaukee, WI
| | - Gary R Seabrook
- Division of Vascular Surgery at Medical College of Wisconsin, Milwaukee, WI
| | - Brian D Lewis
- Division of Vascular Surgery at Medical College of Wisconsin, Milwaukee, WI
| | - Bhavin Patel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Sreyreath Kuy
- Department of Surgery, University General Hospital, Houston, TX
| | - Cheong J Lee
- Division of Vascular Surgery at Medical College of Wisconsin, Milwaukee, WI
| | - Rishi Subbarayan
- Division of Vascular Surgery at Medical College of Wisconsin, Milwaukee, WI
| | - Kellie R Brown
- Division of Vascular Surgery at Medical College of Wisconsin, Milwaukee, WI
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De Rango P, Brown MM, Leys D, Didier L, Howard VJ, Moore WS, Paciaroni M, Ringleb P, Rockman C, Caso V. Management of carotid stenosis in women: consensus document. Neurology 2013; 80:2258-68. [PMID: 23751919 DOI: 10.1212/wnl.0b013e318296e952] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Specific guidelines for management of cerebrovascular risk in women are currently lacking. This study aims to provide a consensus expert opinion to help make clinical decisions in women with carotid stenosis. METHODS Proposals for the use of carotid endarterectomy (CEA), carotid stenting (CAS), and medical therapy for stroke prevention in women with carotid stenosis were provided by a group of 9 international experts with consensus method. RESULTS Symptomatic women with severe carotid stenosis can be managed by CEA provided that the perioperative risk of the operators is low (<4%). Periprocedural stroke risks may be increased in symptomatic women if revascularization is performed by CAS; however, the choice of CAS vs CEA can be tailored in subgroups best fit for each procedure (e.g., women with restenosis or severe coronary disease, best suited for CAS; women with tortuous vessels or old age, best suited for CEA). There is currently limited evidence to consider medical therapy alone as the best choice for women with neurologically severe asymptomatic carotid stenosis, who should be best managed within randomized trials including a medical arm. Medical management and cardiovascular risk factor control must be implemented in all women with carotid stenosis in periprocedural period and lifelong regardless of whether or not intervention is planned. CONCLUSIONS The suggestions provided in this article may constitute a decision-making basis for planning treatment of carotid stenosis in women. Most recommendations are of limited strength; however, it is unlikely that new robust data will emerge soon to induce relevant changes.
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Affiliation(s)
- Paola De Rango
- Vascular and Endovascular Surgery, Hospital S.M. Misericordia, Perugia, Italy.
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Walker JP, Hiramoto JS. Diagnosis and management of peripheral artery disease in women. Int J Womens Health 2012; 4:625-34. [PMID: 23277744 PMCID: PMC3531989 DOI: 10.2147/ijwh.s31073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Peripheral artery disease (PAD) is a significant cause of morbidity and mortality in the USA. Not only is it a major cause of functional impairment and limb loss, but it is also strongly associated with an increased risk of myocardial infarction, stroke, and death. Large population studies have demonstrated high rates of PAD in women, but this is not widely recognized by the public or by clinicians. One potential reason for this is that women with PAD are more likely than men to be asymptomatic or have atypical symptoms. In addition, women with PAD experience higher rates of functional decline and may have poorer outcomes after surgical treatment for PAD compared with men. Currently, it is not known if there are sex-specific differences in risk factors for the onset, progression, and surgical outcomes of PAD. This review will focus on the diagnosis and management of PAD in women and examine sex-specific differences in the prevalence, risk factors, presentation, and outcomes of this disease.
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Affiliation(s)
- Joy Peacock Walker
- Department of Surgery, University of California, San Francisco, California, USA
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