دورية أكاديمية
أعرض في EDS

Presentation, treatment, and outcome differences between men and women undergoing revascularization or amputation for lower extremity peripheral arterial disease.

التفاصيل البيبلوغرافية
العنوان: Presentation, treatment, and outcome differences between men and women undergoing revascularization or amputation for lower extremity peripheral arterial disease.
المؤلفون: Lo RC; Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass., Bensley RP; Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass., Dahlberg SE; Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass., Matyal R; Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass., Hamdan AD; Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass., Wyers M; Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass., Chaikof EL; Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass., Schermerhorn ML; Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass. Electronic address: mscherm@bidmc.harvard.edu.
المصدر: Journal of vascular surgery [J Vasc Surg] 2014 Feb; Vol. 59 (2), pp. 409-418.e3. Date of Electronic Publication: 2013 Sep 29.
نوع المنشور: Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural
اللغة: English
بيانات الدورية: Publisher: Elsevier Country of Publication: United States NLM ID: 8407742 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6809 (Electronic) Linking ISSN: 07415214 NLM ISO Abbreviation: J Vasc Surg Subsets: MEDLINE
أسماء مطبوعة: Publication: <2008-> : New York, NY : Elsevier
Original Publication: St. Louis, Mo. : Mosby, [c1984-
مواضيع طبية MeSH: Amputation, Surgical*/adverse effects , Amputation, Surgical*/mortality , Angioplasty, Balloon*/adverse effects , Angioplasty, Balloon*/instrumentation , Angioplasty, Balloon*/mortality , Health Status Disparities* , Healthcare Disparities* , Vascular Surgical Procedures*/adverse effects , Vascular Surgical Procedures*/instrumentation , Vascular Surgical Procedures*/mortality, Intermittent Claudication/*therapy , Ischemia/*therapy , Lower Extremity/*blood supply , Peripheral Arterial Disease/*therapy, Age Factors ; Aged ; Chi-Square Distribution ; Female ; Hospital Mortality ; Humans ; Intermittent Claudication/diagnosis ; Intermittent Claudication/mortality ; Ischemia/diagnosis ; Ischemia/mortality ; Limb Salvage ; Logistic Models ; Male ; Multivariate Analysis ; Odds Ratio ; Peripheral Arterial Disease/diagnosis ; Peripheral Arterial Disease/mortality ; Risk Factors ; Sex Factors ; Stents ; Time Factors ; Treatment Outcome ; United States
مستخلص: Objective: Prior studies have suggested treatment and outcome disparities between men and women for lower extremity peripheral arterial disease after surgical bypass. Given the recent shift toward endovascular therapy, which has increasingly been used to treat claudication, we sought to analyze sex disparities in presentation, revascularization, amputation, and inpatient mortality.
Methods: We identified individuals with intermittent claudication and critical limb ischemia (CLI) using International Classification of Diseases, Ninth Revision codes in the Nationwide Inpatient Sample from 1998 to 2009. We compared presentation at time of intervention (intermittent claudication vs CLI), procedure (open surgery vs percutaneous transluminal angioplasty or stenting vs major amputation), and in-hospital mortality for men and women. Regional and ambulatory trends were evaluated by performing a separate analysis of the State Inpatient and Ambulatory Surgery Databases from four geographically diverse states: California, Florida, Maryland, and New Jersey.
Results: From the Nationwide Inpatient Sample, we identified 1,797,885 patients (56% male) with intermittent claudication (26%) and CLI (74%), who underwent 1,865,999 procedures (41% open surgery, 20% percutaneous transluminal angioplasty or stenting, and 24% amputation). Women were older at the time of intervention by 3.5 years on average and more likely to present with CLI (75.9% vs 72.3%; odds ratio [OR], 1.21; 95% confidence interval [CI], 1.21-1.23; P < .01). Women were more likely to undergo endovascular procedures for both intermittent claudication (47% vs 41%; OR, 1.27; 95% CI, 1.25-1.28; P < .01) and CLI (21% vs 19%; OR, 1.14; 95% CI, 1.13-1.15; P < .01). From 1998 to 2009, major amputations declined from 18 to 11 per 100,000 in men and 16 to 7 per 100,000 in women, predating an increase in total CLI revascularization procedures that was seen starting in 2005 for both men and women. In-hospital mortality was higher in women regardless of disease severity or procedure performed even after adjusting for age and baseline comorbidities (.5% vs .2% after percutaneous transluminal angioplasty or stenting for intermittent claudication; 1.0% vs .7% after open surgery for intermittent claudication; 2.3% vs 1.6% after percutaneous transluminal angioplasty or stenting for CLI; 2.7% vs 2.2% after open surgery for CLI; P < .01 for all comparisons).
Conclusions: There appears to be a preference to perform endovascular over surgical revascularization among women, who are older and have more advanced disease at presentation. Percutaneous transluminal angioplasty or stenting continues to be popular and is increasingly being performed in the outpatient setting. Amputation and in-hospital mortality rates have been declining, and women now have lower amputation but higher mortality rates than men. Recent improvements in outcomes are likely the result of a combination of improved medical management and risk factor reduction.
(Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)
التعليقات: Comment in: J Vasc Surg. 2014 Jul;60(1):271-2. (PMID: 24970664)
References: J Vasc Surg. 2010 Nov;52(5):1196-202. (PMID: 20674247)
J Vasc Surg. 2006 Feb;43(2):230-8; discussion 238. (PMID: 16476592)
J Vasc Surg. 2000 Jan;31(1 Pt 1):134-46. (PMID: 10642716)
J Vasc Surg. 2011 Oct;54(4):1021-1031.e1. (PMID: 21880457)
N Engl J Med. 1998 Nov 12;339(20):1415-25. (PMID: 9811916)
J Vasc Surg. 2006 Feb;43(2):205-16. (PMID: 16476588)
Ann Vasc Surg. 2011 Feb;25(2):191-6. (PMID: 21131175)
J Vasc Surg. 2012 Aug;56(2):343-52. (PMID: 22575482)
J Vasc Surg. 2002 May;35(5):882-6. (PMID: 12021702)
J Vasc Surg. 2003 Jul;38(1):93-8. (PMID: 12844096)
J Vasc Surg. 1999 May;29(5):807-12; discussion 812-3. (PMID: 10231631)
Eur J Vasc Endovasc Surg. 2002 Sep;24(3):245-8. (PMID: 12217287)
Int Angiol. 2008 Jun;27(3):232-8. (PMID: 18506126)
Womens Health Issues. 2007 May-Jun;17(3):120-30. (PMID: 17448685)
J Vasc Surg. 2010 Feb;51(2):372-8.e1; discussion 378-9. (PMID: 20022204)
J Vasc Surg. 2009 Jul;50(1):54-60. (PMID: 19481407)
J Vasc Surg. 2010 May;51(5 Suppl):1S-4S. (PMID: 20435257)
Lancet. 1998 Nov 21;352(9141):1649-55. (PMID: 9853436)
Am Surg. 2011 Jul;77(7):844-9. (PMID: 21944345)
Health Technol Assess. 2010 Mar;14(14):1-210, iii-iv. (PMID: 20307380)
Womens Health Issues. 2007 May-Jun;17(3):150-61. (PMID: 17475506)
J Thorac Cardiovasc Surg. 2004 Feb;127(2):318-21. (PMID: 14762336)
J Vasc Interv Radiol. 2000 Jan;11(1):45-9. (PMID: 10693712)
Arch Intern Med. 2000 Feb 14;160(3):343-7. (PMID: 10668836)
J Vasc Surg. 2006 Jul;44(1):115-8. (PMID: 16730157)
J Vasc Surg. 1993 Jan;17(1):67-76; discussion 76-8. (PMID: 8421343)
J Vasc Surg. 2011 Apr;53(4):1020-5. (PMID: 21211929)
Vasc Med. 2011 Dec;16(6):428-35. (PMID: 22128042)
J Vasc Surg. 2009 Apr;49(4):910-7. (PMID: 19341885)
Diabetes Care. 2005 Mar;28(3):514-20. (PMID: 15735180)
JAMA. 1995 Nov 15;274(19):1506; author reply 1506-7. (PMID: 7474211)
J Vasc Surg. 1997 Jan;25(1):29-38. (PMID: 9013905)
Semin Vasc Surg. 2009 Dec;22(4):267-74. (PMID: 20006808)
معلومات مُعتمدة: T32 HL007734 United States HL NHLBI NIH HHS; HL007734 United States HL NHLBI NIH HHS
تواريخ الأحداث: Date Created: 20131002 Date Completed: 20140320 Latest Revision: 20221207
رمز التحديث: 20221213
مُعرف محوري في PubMed: PMC3946884
DOI: 10.1016/j.jvs.2013.07.114
PMID: 24080134
قاعدة البيانات: MEDLINE
الوصف
تدمد:1097-6809
DOI:10.1016/j.jvs.2013.07.114