The impact of female sex on the outcomes of endovascular treatment for iliac lesions

Objective: The aim of this study was to evaluate early and long-term outcomes of stenting for iliac obstructive disease in women, comparing their results with those of men. Methods: A single-center retrospective analysis of iliac stenting procedures performed from 2010 to 2017 was conducted. Perioperative clinical, anatomic, and operative data, including mean artery diameters and stent diameters, were collected in a dedicated database. Early outcomes and long-term patency rates were compared between men and women; Cox proportional hazards modeling was used to identify independent predictors of patency. Results: There were 210 patients (298 limbs; women, n = 80 limbs [33%]; men, n = 218 limbs [66%]) treated. In comparing women with men, there were no differences in comorbidities (Society for Vascular Surgery score: women, 0.81 ± 0.54; men, 0.84 ± 0.60; P =.69) and TransAtlantic Inter-Society Consensus (TASC) classification (P =.49). At presentation, women had more advanced symptoms (Rutherford categories 5 and 6: women, 36.2%; men, 23.8%; P =.039) and smaller diameter at the level of the aortic bifurcation (women, 14.5 ± 3.6 mm; men, 16.0 ± 3.3 mm; P =.017), common iliac artery (women, 9.3 ± 1.5 mm; men, 10.0 ± 1.6 mm; P <.001), external iliac artery (EIA; women, 8.7 ± 1.5 mm; men, 10.1 ± 2.6 mm; P =.006), and common femoral artery (women, 7.3 ± 2.0 mm; men, 8.5 ± 2.1 mm; P =.034); similarly, the mean stent diameter was smaller (women, 8.9 ± 1.7 mm; men, 10.1 ± 4.4 mm; P =.03). The 30-day medical (P =.22) and surgical (P =.50) complication rates were similar. At 72 months, women had lower primary patency (women, 71%; men, 88%; P =.020) and secondary patency (women, 83%; men, 97%; P <.001) rates compared with men, whereas limb salvage rate was similar (women, 96%; men, 99%; P =.501). Multivariable analysis showed that female sex (hazard ratio [HR], 2.49; P =.04), ischemic tissue loss (HR, 2.48; P =.04), and stent diameter ≤7 mm (HR, 2.86; P =.01) were overall negative predictors of patency. Within women, EIA involvement (HR, 2.01; P =.04) and stent diameter ≤7 mm (HR, 3.79; P =.12) were also negative predictors. Conclusions: Iliac stenting shows similarly good early outcomes in women and men. However, in the long term, primary and secondary patency rates are significantly lower in women, and this may be explained by smaller arterial diameter. In particular, a stent diameter ≤7 mm and EIA stenting were negative predictors of patency.