Female Sex Is Associated with More Reinterventions After Endovascular and Open Interventions for Intermittent Claudication

Document Type


Publication Date




Journal Title

Annals of vascular surgery


OBJECTIVE: 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. METHODS: 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. RESULTS: 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 < .05). Female compared with male patients had lower one-year reintervention-free survival after PVI (84.4% ± 0.3% vs. 86.3% ± 0.2%, p < .001), IIB (79.0% ± 0.9% vs. 81.2% ± 0.6%, p = .04), and SIB (89.4% ± 0.9% vs. 92.6% ± 0.7%, p = .005), but similar amputation-free survival and survival across all procedures. Multivariable analysis confirmed that female sex was associated with increased one-year reintervention for PVI (HR 1.16, 95% CI 1.09-1.24, p < .001), IIB, (HR 1.16, 95% CI 1.03-1.31, p = .02), and SIB (HR 1.60, 95% CI 1.20-2.13, p = .001). CONCLUSIONS: 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 patients.