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J Thorac Cardiovasc Surg 2004;127:318-321
© 2004 The American Association for Thoracic Surgery

Editorial

Arterial occlusive disease of the lower extremities: Do women differ from men in occurrence of risk factors and response to invasive treatment?

^a Division of TCV Surgery, University of Virginia Health System, Charlottesville, Va, USA
^b Division of Vascular Surgery, University of Maryland, Baltimore, Md, USA
^c Department of Vascular Surgery, the Cleveland Clinic Foundation, Cleveland, Ohio, USA
^d Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md, USA
^e Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn, USA

Received for publication September 29, 2003; accepted for publication October 6, 2003.

^* Address for reprints: Vivian Gahtan, MD, SUNY Upstate Medical University College of Medicine, Department of Surgery, 750 East Adams St, Syracuse, NY 13210 , USA
gahtanv@upstate.edu

The first 300 words of the full text of this article appear below.

Results of lower extremity revascularization for peripheral arterial occlusive disease (PAD) are difficult to analyze because a multitude of factors might have a significant effect on outcome. These factors include the following: (1) the indication to intervene (claudication, rest pain, or tissue loss); (2) the location or locations of hemodynamically significant atherosclerotic plaque; (3) the number of associated arterial segments affected by disease; (4) the diameter of treated arterial segments; (5) the intervention performed; (6) the type and quality of the conduit if a bypass graft is performed; and (7) the ability of the patient and health care team to reduce risk factors (control diabetes, hyperlipidemia, and hypertension and reduce or stop cigarette smoking). For example, unilateral inflow disease might involve occlusion or stenosis of the common iliac artery, the external iliac artery (EIA), or both. Treatment options include axillofemoral, iliofemoral, or femoral-femoral bypass grafting; aortobifemoral bypass grafting; or percutaneous revascularization with angioplasty, stenting, or both. Each patient might have multiple important issues to consider, and therefore comparing patients while controlling for all these variables is a monumental task. Despite the obstacles, many investigators have attempted to control the wide array of variables to determine whether a significant difference in outcomes exists for men and women. For this article, both surgical infrainguinal revascularization and percutaneous and surgical treatment of aortoiliac occlusive disease are considered.

Infrainguinal arterial bypass grafting

Most of the studies that examine infrainguinal surgical revascularization in women are retrospective analyses from a single institution. Unfortunately, this type of study has resulted in frequent comparisons of dissimilar patient groups (Table 1). ^1-6 Only 2 studies compared men and women who had no significant differences regarding age, smoking history, and incidence of diabetes.^5,6 In the other reports, women were significantly older than men.^1-4 The frequency of risk factors, especially smoking and diabetes mellitus, . . . [Full Text of this Article]