June 06, 2017
3 min read

In endovascular therapy for PAD, women exhibit more advanced disease, worse outcomes than men

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Among patients who underwent endovascular interventions for superficial femoral artery or popliteal artery disease, women presented with worse disease and had poorer outcomes compared with men, according to findings presented at the Society for Vascular Surgery Vascular Annual Meeting.

Angela Kokkosis, MD, assistant professor of surgery at Stony Brook Medicine, New York, and colleagues evaluated 12,338 patients (41% women) from the national Vascular Quality Initiative database who had an endovascular intervention for superficial femoral artery or popliteal artery disease between July 2014 and October 2016.

Patients were compared by sex for differences in presentation and patency outcomes. The results were presented by Jung Yun, medical student at Stony Brook Medical Center.

Angela Kokkosis, MD
Angela Kokkosis

“Throughout the literature, the prevalence of [peripheral artery disease] is equivalent in men and women; however, when you look at the practice patterns, more males are diagnosed and treated for PAD,” Kokkosis told Cardiology Today’s Intervention. “Furthermore, clinical studies on the treatment and outcomes of females with PAD are largely underrepresented and demonstrate inferior outcomes in females. Five years have passed since [an American Heart Association statement on under-recognition of PAD in women], and there’s been no change in public health awareness and screening. With this knowledge, we sought to investigate current presentations and outcomes of PAD in females using a new tool created by the Society for Vascular Surgery, the Vascular Quality Initiative.”

Although men were more likely to smoke (P < .0001) and have prior CAD (P < .0001), women were more likely to have prior hypertension (P = .0008) and diabetes (P = .0337), according to the researchers.

“It was interesting to see that females were less likely to present with a history of coronary disease,” Kokkosis said. “This is a finding which is counterintuitive because vascular disease is in fact a systemic disease, thus any patient with PAD has a high likelihood of concomitant CAD. It’s possible that the decreased recognition of CAD in females may still even persist today.”

Compared with men, women presented with a lower ankle-brachial index (P < .0001), even when matched for age.

Men were more likely to present with claudication but women were more likely to present with rest pain or tissue loss (P < .0001 for both), even when matched for age, the researchers found.

One year after the procedure, primary patency was lower for women than men (73% vs. 79%; P < .0001), and after matching for risk factors, women had worse outcomes in terms of smoking (79% vs. 73%; P < .0001), hypertension (78% vs. 73%; P < .0001), diabetes (78% vs. 73%; P = .0012) and CAD (80% vs. 74%; P = .0032), according to the researchers.


Also at 1 year, women were less likely than men to be ambulatory with or without assistance (P = .0008).

“Females are still presenting later in the disease process with poorer outcomes compared with their male counterparts,” Kokkosis told Cardiology Today’s Intervention. “This further compounds the possibility that ‘old-school thinking’ persists among health care providers in the public that PAD is more prevalent in males.”

The difference in patency rates was consistent among those aged 50 to 69 years (women, 73%; men, 77%; P = .0026) and those aged 70 years or older (women, 74%; men, 82%; P < .0001).

“The focus right now should be at the primary care level,” Kokkosis said. “It’s important for these practitioners to recognize the common risk factors for PAD in their patients in general, which are smoking, hypertension, hyperlipidemia, diabetes and renal disease, and then to perform, at the minimum, a routine pulse exam on those patients. Unfortunately, it is believed that females who present with leg pain are more likely to be thought to have arthritis or spinal stenosis, and thus the clinical suspicion of PAD is not there.”

More studies are needed “to develop increased awareness and possibly screening guidelines for females of a certain age with certain risk factors who may have PAD,” she said. “As with any chronic disease process, recognition of progression is key.” – by Erik Swain


Yun J, et al. S8: Plenary Session 8. Presented at: Society for Vascular Surgery Vascular Annual Meeting; May 31-June 3, 2017; San Diego.

Disclosure: Kokkosis and Yun report no relevant financial disclosures.