Introduction:

Peripheral Arterial Disease (PAD) affects more than 200 million people. Its estimated prevalence in women ranges from 3% to 29%. Asymptomatic PAD is more common in women than in men. However, when symptomatic, females present a more complex disease, severe critical limb-threatening ischemia (CLTI), and worse outcomes. This study aims to characterize PAD in hospitalized women, evaluating risk factors, clinical presentation, therapeutic strategies, and outcomes.

Methods:

An observational, retrospective, longitudinal study of a single institution was conducted. The study included consecutive patients admitted with a clinical diagnosis of PAD (intermittent claudication or CLTI), confirmed by the ankle-brachial index (ABI), between January 2018 and December 2019. Recorded data comprised: clinical presentation, comorbidities, chronic medication, length of stay, type of admission, type of treatment (medical; surgical revascularization; endovascular treatment; major amputation; minor amputation), outcomes: discharge destination, successful revascularization, 30-day mortality, and amputation-free survival.

Results:

We analyzed 158 patients (51 females). Women had a higher mean age (76.5±10.4 years vs 69.5±10.6 years; p<0.001). Women also had lower smoking habits (4.0% vs 58.9%, p<0.001), higher prevalence of arterial hypertension (90.2% vs 73.8%, p=0.021), diabetes mellitus (74.5% vs 57.0%, p=0.036) and depression (7.0% vs 0.9%, p=0.002). Females presented with higher rates of CLTI (98.0% vs 87.9% p=0.038) and decreased functional status on admission (28.0% vs 4.3%, p<0.001). Females had fewer aortoiliac interventions (18.0% vs 50.0% p=0.012). In patients with CLTI, men were more often revascularized by conventional surgery (18.0% vs 41.5%, p=0.005). On the other hand, the major amputation rate was higher in women (40.0% vs 21.3%, p=0.020). Through univariate analysis, it was found that women with CLTI had a 2.47 times higher risk of major amputation than men with CLTI (p=0.018). However, in multivariate analysis, gender was not considered an independent predictor of major amputation, with age being the main factor. In patients revascularized for CLTI (21 females and 54 males), the successful revascularization rate was similar between genders (90.5% in females and 90.7% in males, p>0.99). Regarding 30-day mortality for CLTI, we found that 6 women (12.0%) and 5 men (5.3%) died. No statistically significant differences were found (p=0.191). No significant differences were found between genders, concerning the outcomes: length of stay, discharge destination, and amputation-free survival.

Conclusion:

Females were older, more dependent, and more frequently admitted with CLTI, with a consequently higher major amputation rate. Besides prompt diagnosis, and intervention, public and social health measures are needed to improve functional status in elderly women to reduce female amputation rates.

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