Semin intervent Radiol 2018; 35(01): 009-016
DOI: 10.1055/s-0038-1636515
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Gender Differences in Peripheral Vascular Disease

Kristofer Schramm
1   Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
,
Paul J. Rochon
1   Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
› Author Affiliations
Further Information

Publication History

Publication Date:
05 April 2018 (online)

Abstract

In the past 20 years, peripheral artery disease (PAD) has been increasingly recognized as a significant cause of morbidity and mortality in the United States. PAD has traditionally been identified as a male-dominant disease; however, recent population trends and studies in PAD suggest that women are affected at least as often as men. Women comprise a larger population of the elderly than men, as well as an increasing proportion of patients with PAD. Much of the existing research on PAD has focused on whole populations, and gender-specific data on PAD is sparse. This review focuses on gender-specific differences in presentation, management, and outcomes of PAD intervention that are important considerations for the interventional radiologist.

 
  • References

  • 1 Kochanek KD, Murphy SL, Xu J, Tejada-Vera B. Deaths: final data for 2014. Natl Vital Stat Rep 2016; 65 (04) 1-122
  • 2 Taylor SM. Commentary. Gaps in public knowledge of peripheral arterial disease: the first national PAD public awareness survey. Perspect Vasc Surg Endovasc Ther 2008; 20 (03) 314-316
  • 3 Wenger NK. Women and coronary heart disease: a century after Herrick: understudied, underdiagnosed, and undertreated. Circulation 2012; 126 (05) 604-611
  • 4 Mahoney EM, Wang K, Cohen DJ. , et al; REACH Registry Investigators. One-year costs in patients with a history of or at risk for atherothrombosis in the United States. Circ Cardiovasc Qual Outcomes 2008; 1 (01) 38-45
  • 5 Walker JP, Hiramoto JS. Diagnosis and management of peripheral artery disease in women. Int J Womens Health 2012; 4: 625-634
  • 6 Hoel AW, Kayssi A, Brahmanandam S, Belkin M, Conte MS, Nguyen LL. Under-representation of women and ethnic minorities in vascular surgery randomized controlled trials. J Vasc Surg 2009; 50 (02) 349-354
  • 7 Mendis S, Puska P, Norrving B. Global Atlas on Cardiovascular Disease Prevention and Control. World Health Organization; 2011
  • 8 Kuller LH, Matthews KA, Edmundowicz D, Chang Y. Incident coronary artery calcium among postmenopausal women. Atherosclerosis 2008; 200 (02) 278-285
  • 9 Daviglus ML, Stamler J, Pirzada A. , et al. Favorable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality. JAMA 2004; 292 (13) 1588-1592
  • 10 Willigendael EM, Teijink JA, Bartelink M-L. , et al. Influence of smoking on incidence and prevalence of peripheral arterial disease. J Vasc Surg 2004; 40 (06) 1158-1165
  • 11 Price JF, Mowbray PI, Lee AJ, Rumley A, Lowe GD, Fowkes FG. Relationship between smoking and cardiovascular risk factors in the development of peripheral arterial disease and coronary artery disease: Edinburgh Artery Study. Eur Heart J 1999; 20 (05) 344-353
  • 12 Jamal A, Homa DM, O'Connor E. , et al. Current cigarette smoking among adults - United States, 2005-2014. MMWR Morb Mortal Wkly Rep 2015; 64 (44) 1233-1240
  • 13 Westendorp IC, in't Veld BA, Grobbee DE. , et al. Hormone replacement therapy and peripheral arterial disease: the Rotterdam study. Arch Intern Med 2000; 160 (16) 2498-2502
  • 14 Rossouw JE, Anderson GL, Prentice RL. , et al; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002; 288 (03) 321-333
  • 15 Grady D, Herrington D, Bittner V. , et al; HERS Research Group. Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA 2002; 288 (01) 49-57
  • 16 Hsia J, Criqui MH, Herrington DM. , et al; Women's Health Initiative Research Group. Conjugated equine estrogens and peripheral arterial disease risk: the Women's Health Initiative. Am Heart J 2006; 152 (01) 170-176
  • 17 Pyörälä K, Laakso M, Uusitupa M. Diabetes and atherosclerosis: an epidemiologic view. Diabetes Metab Rev 1987; 3 (02) 463-524
  • 18 Brun E, Nelson RG, Bennett PH. , et al; Verona Diabetes Study. Diabetes duration and cause-specific mortality in the Verona Diabetes Study. Diabetes Care 2000; 23 (08) 1119-1123
  • 19 Kannel WB, McGee DL. Update on some epidemiologic features of intermittent claudication: the Framingham Study. J Am Geriatr Soc 1985; 33 (01) 13-18
  • 20 Smith Jr SC, Haslam D. Abdominal obesity, waist circumference and cardio-metabolic risk: awareness among primary care physicians, the general population and patients at risk--the Shape of the Nations survey. Curr Med Res Opin 2007; 23 (01) 29-47
  • 21 Cabrera MA, Gebara OC, Diament J, Nussbacher A, Rosano G, Wajngarten M. Metabolic syndrome, abdominal obesity, and cardiovascular risk in elderly women. Int J Cardiol 2007; 114 (02) 224-229
  • 22 Berg AH, Scherer PE. Adipose tissue, inflammation, and cardiovascular disease. Circ Res 2005; 96 (09) 939-949
  • 23 Giusti V. Management of obesity in patients with peripheral arterial disease. Eur J Vasc Endovasc Surg 2007; 34 (05) 576-582
  • 24 Yao ST, Hobbs JT, Irvine WT. Ankle systolic pressure measurements in arterial disease affecting the lower extremities. Br J Surg 1969; 56 (09) 676-679
  • 25 Rooke TW, Hirsch AT, Misra S. , et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society for Vascular Medicine; Society for Vascular Surgery. 2011 ACCF/AHA Focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guideline. J Vasc Surg 2011; 54 (05) e32-e58
  • 26 Criqui MH, Aboyans V. Epidemiology of peripheral artery disease. Circ Res 2015; 116 (09) 1509-1526
  • 27 Allison MA, Ho E, Denenberg JO. , et al. Ethnic-specific prevalence of peripheral arterial disease in the United States. Am J Prev Med 2007; 32 (04) 328-333
  • 28 Hirsch AT, Allison MA, Gomes AS. , et al. A call to action: women and peripheral artery disease. Circulation 2012; 125 (11) 1449-1472
  • 29 Diehm C, Schuster A, Allenberg JR. , et al. High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis 2004; 172 (01) 95-105
  • 30 Hirsch AT, Criqui MH, Treat-Jacobson D. , et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA 2001; 286 (11) 1317-1324
  • 31 Sigvant B, Wiberg-Hedman K, Bergqvist D. , et al. A population-based study of peripheral arterial disease prevalence with special focus on critical limb ischemia and sex differences. J Vasc Surg 2007; 45 (06) 1185-1191
  • 32 McDermott MM, Greenland P, Liu K. , et al. The ankle brachial index is associated with leg function and physical activity: the Walking and Leg Circulation Study. Ann Intern Med 2002; 136 (12) 873-883
  • 33 McDermott MM, Fried L, Simonsick E, Ling S, Guralnik JM. Asymptomatic peripheral arterial disease is independently associated with impaired lower extremity functioning: the women's health and aging study. Circulation 2000; 101 (09) 1007-1012
  • 34 McDermott MM, Greenland P, Liu K. , et al. Sex differences in peripheral arterial disease: leg symptoms and physical functioning. J Am Geriatr Soc 2003; 51 (02) 222-228
  • 35 Mazhari R, Hsia J. Prevalence, clinical significance, and management of peripheral arterial disease in women: is there a role for postmenopausal hormone therapy?. Vasc Health Risk Manag 2005; 1 (02) 111-117
  • 36 Hobbs SD, Bradbury AW. Smoking cessation strategies in patients with peripheral arterial disease: an evidence-based approach. Eur J Vasc Endovasc Surg 2003; 26 (04) 341-347
  • 37 Robless P, Mikhailidis DP, Stansby GP. Cilostazol for peripheral arterial disease. Cochrane Database Syst Rev 2008; (01) CD003748
  • 38 Pande RL, Hiatt WR, Zhang P, Hittel N, Creager MA. A pooled analysis of the durability and predictors of treatment response of cilostazol in patients with intermittent claudication. Vasc Med 2010; 15 (03) 181-188
  • 39 Lane R, Ellis B, Watson L, Leng GC. Exercise for intermittent claudication. Cochrane Database Syst Rev 2014; (07) CD000990
  • 40 Conte MS, Pomposelli FB, Clair DG. , et al; Society for Vascular Surgery Lower Extremity Guidelines Writing Group; Society for Vascular Surgery. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg 2015; 61 (3, Suppl): 2S-41S
  • 41 Lundgren F, Dahllöf AG, Lundholm K, Scherstén T, Volkmann R. Intermittent claudication--surgical reconstruction or physical training? A prospective randomized trial of treatment efficiency. Ann Surg 1989; 209 (03) 346-355
  • 42 Trialists'Collaboration A. ; Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324 (7329): 71-86
  • 43 Belch J, MacCuish A, Campbell I. , et al; Prevention of Progression of Arterial Disease and Diabetes Study Group; Diabetes Registry Group; Royal College of Physicians Edinburgh. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ 2008; 337: a1840
  • 44 Feinglass J, McDermott MM, Foroohar M, Pearce WH. Gender differences in interventional management of peripheral vascular disease: evidence from a blood flow laboratory population. Ann Vasc Surg 1994; 8 (04) 343-349
  • 45 Egorova N, Vouyouka AG, Quin J. , et al. Analysis of gender-related differences in lower extremity peripheral arterial disease. J Vasc Surg 2010; 51 (02) 372-8.e1 , discussion 378–379
  • 46 Lancaster RT, Conrad MF, Patel VI, Cambria RP, LaMuraglia GM. Predictors of early graft failure after infrainguinal bypass surgery: a risk-adjusted analysis from the NSQIP. Eur J Vasc Endovasc Surg 2012; 43 (05) 549-555
  • 47 Nguyen LL, Brahmanandam S, Bandyk DF. , et al. Female gender and oral anticoagulants are associated with wound complications in lower extremity vein bypass: an analysis of 1404 operations for critical limb ischemia. J Vasc Surg 2007; 46 (06) 1191-1197
  • 48 Jain AK, Velazquez-Ramirez G, Goodney PP, Edwards MS, Corriere MA. Gender-based analysis of perioperative outcomes associated with lower extremity bypass. Am Surg 2011; 77 (07) 844-849
  • 49 Vouyouka AG, Egorova NN, Salloum A. , et al. Lessons learned from the analysis of gender effect on risk factors and procedural outcomes of lower extremity arterial disease. J Vasc Surg 2010; 52 (05) 1196-1202
  • 50 Pulli R, Dorigo W, Pratesi G, Fargion A, Angiletta D, Pratesi C. Gender-related outcomes in the endovascular treatment of infrainguinal arterial obstructive disease. J Vasc Surg 2012; 55 (01) 105-112
  • 51 Jackson EA, Munir K, Schreiber T. , et al. Impact of sex on morbidity and mortality rates after lower extremity interventions for peripheral arterial disease: observations from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. J Am Coll Cardiol 2014; 63 (23) 2525-2530
  • 52 Gallagher KA, Meltzer AJ, Ravin RA. , et al. Gender differences in outcomes of endovascular treatment of infrainguinal peripheral artery disease. Vasc Endovascular Surg 2011; 45 (08) 703-711
  • 53 Norgren L, Hiatt WR, Dormandy JA. , et al; TASC II Working Group. Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg 2007; 33 (01) (Suppl. 01) S1-S75
  • 54 Goode SD, Cleveland TJ, Gaines PA. ; STAG Trial Collaborators. Randomized clinical trial of stents versus angioplasty for the treatment of iliac artery occlusions (STAG trial). Br J Surg 2013; 100 (09) 1148-1153
  • 55 Timaran CH, Stevens SL, Freeman MB, Goldman MH. External iliac and common iliac artery angioplasty and stenting in men and women. J Vasc Surg 2001; 34 (03) 440-446
  • 56 Bechter-Hugl B, Falkensammer J, Gorny O, Greiner A, Chemelli A, Fraedrich G. The influence of gender on patency rates after iliac artery stenting. J Vasc Surg 2014; 59 (06) 1588-1596
  • 57 Krankenberg H, Schlüter M, Steinkamp HJ. , et al. Nitinol stent implantation versus percutaneous transluminal angioplasty in superficial femoral artery lesions up to 10 cm in length: the femoral artery stenting trial (FAST). Circulation 2007; 116 (03) 285-292
  • 58 Tadros RO, Vouyouka AG, Ting W. , et al. A review of superficial femoral artery angioplasty and stenting. J Vasc Med Surg 2015; 3: 183
  • 59 Romiti M, Albers M, Brochado-Neto FC, Durazzo AES, Pereira CAB, De Luccia N. Meta-analysis of infrapopliteal angioplasty for chronic critical limb ischemia. J Vasc Surg 2008; 47 (05) 975-981
  • 60 Schmidt A, Ulrich M, Winkler B. , et al. Angiographic patency and clinical outcome after balloon-angioplasty for extensive infrapopliteal arterial disease. Catheter Cardiovasc Interv 2010; 76 (07) 1047-1054
  • 61 Scheinert D, Katsanos K, Zeller T. , et al; ACHILLES Investigators. A prospective randomized multicenter comparison of balloon angioplasty and infrapopliteal stenting with the sirolimus-eluting stent in patients with ischemic peripheral arterial disease: 1-year results from the ACHILLES trial. J Am Coll Cardiol 2012; 60 (22) 2290-2295