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ABSTRACT: BACKGROUND: Statin use results in atherosclerotic plaque stabilization. We sought to determine the effects of statins on the size and number of embolic particles generated during carotid artery stenting (CAS). METHODS: Embolic debris from carotid filters following CAS was analyzed using photomicroscopy and imaging software. Patient comorbidities, pre-operative cerebrovascular symptoms, statin use, and outcomes (peri-operative major adverse events, MAE) were reviewed. RESULTS: Carotid filters from 62 consecutive CAS procedures were examined. The mean age is 68.7 ± 9.8 years, 64% were men, 41 (66%) were on statins at the time of CAS, and 27 (43.5%) had neurological symptoms pre-procedurally. The mean intra-procedural stenosis was similar between groups (statin: 89.4 ± 7.4% vs. no statin: 88.4 ± 5.9%, P = NS). There was no significant difference in overall pre-operative symptoms between the two groups. Statin users were more likely to have coronary artery disease (CAD, P = 0.02), hyperlipidemia (HL, P = 0.047), or have undergone coronary artery bypass (CABG, P = 0.01). Statin use was associated with significantly less embolic particles (statin: 16.4 ± 2.1 vs. no statin: 42.4 ± 9.5, P = 0.001) during CAS. Further, multivariate analysis controlling for CAD, HL, and CABG confirmed that statin use was independently associated with less captured debris (P = 0.005). There was no significant difference in the mean particle size (statin: 326.2 μm ± 31.1 vs. no statin 310.5 μm ± 41.8), peri-procedural stroke, and MAE between the two groups (P = NS). CONCLUSIONS: Statin use is associated with less embolic debris during CAS. Further investigation utilizing a larger study group is necessary to assess the impact of statin use on peri-procedural outcomes.
Annals of Vascular Surgery 10/2012; · 1.03 Impact Factor
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ABSTRACT: OBJECTIVE: The purpose of this study was to identify any gender-associated differences in the percutaneous treatment of infrageniculate lesions in individuals with chronic critical limb ischemia. METHODS: A retrospective chart review was performed on 112 index tibial lesions in 81 consecutive patients operated on from January 2005 to February 2011. All patients were treated for critical limb ischemia-defined as rest pain or tissue loss. Patient demographics, comorbidities, clinical presentation, vascular studies, lesion characteristics, procedures, and postoperative complications were entered into a database for review. Patients were evaluated for primary patency, secondary patency, limb salvage, and mortality rates. RESULTS: Sixty-three index tibial lesions were treated percutaneously in 43 women, compared to 49 lesions in 38 men. There was a trend toward increased cardiac disease (65.8% men vs 44.2% women; P = .052) and smoking (52.6% men vs 32.6% women; P = .070) in men. Men were more likely than women to have TransAtlantic Inter-Society Consensus (TASC) C and D lesions (83.7% vs 65.1%; P = .023) and to be treated for total occlusion (44.9% vs 25.4%; P = .031). There were no significant gender-related differences in length of stay or postoperative complications. Women had statistically better primary patency rates than men at 12 and 24 months (77.5% ± 6.9% and 72.9% ± 7.8% in women vs 58.7% ± 9.3% and 45.2% ± 9.9% in men; P = .032). Women also had statistically better secondary patency rates than men at 12 and 24 months (90.4% ± 4.8% and 85.1% ± 6.8% in women vs 76.0% ± 8.1% and 58.5% ± 10.8% in men; P = .028). Female gender remained an independent predictor of superior patency even after controlling for gender-related differences in TASC grade. There were no significant differences in limb salvage rates at 12 and 24 months (92.1% ± 4.4% and 85.0% ± 7.9% in women vs 88.3% ± 6.4% and 83.4% ± 7.7% in men; P = .985). Overall survival rates were similar (59.8% ± 7.6% for women and 68.0% ± 8.1% for men at 24 months; P = .351). CONCLUSIONS: Percutaneous intervention may be an equally effective or better treatment option for women with chronic limb ischemia and tibial disease when compared to men. In this study, male gender was an independent predictor of poorer primary and secondary patency rates after infrageniculate intervention. There were no differences in postoperative wound complications between genders. Endovascular procedures may lessen the gap in gender-related treatment outcomes and postoperative complications seen after open arterial reconstructions.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 08/2012; · 3.52 Impact Factor
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ABSTRACT: Although large randomized studies have established the efficacy and safety of carotid endarterectomy (CEA) and, recently, carotid artery stenting (CAS), the under-representation of women in these trials leaves the comparison of risks to benefits of performing these procedures on women an open question. To address this issue, we reviewed the hospital outcomes and delineated patient characteristics predicting outcome in women undergoing carotid interventions using New York and Florida statewide hospital discharge databases.
We analyzed in-hospital mortality, postoperative stroke, cardiac postoperative complications, and combined postoperative stoke and mortality in 20,613 CEA or CAS hospitalizations for the years 2007 to 2009. Univariate and multiple logistic regression analyses of variables were performed.
CEA was performed in 16,576 asymptomatic and 1744 symptomatic women and CAS in 1943 asymptomatic and 350 symptomatic women. Compared with CAS, CEA rates, in asymptomatic vs symptomatic, were significantly lower for in-hospital mortality (0.3% vs 0.8% and 0.4% vs 3.4%), stroke (1.5% vs 2.6% and 3.5% vs 9.4%), and combined stroke/mortality (1.7% vs 3.1% and 3.8% vs 10.9%). In cohorts matched by propensity scores, the same trend favoring CEA remained significant in symptomatic women. There was no difference in cardiac complication rates among asymptomatic women, but among symptomatic woman cardiac complications were more frequent after CAS (10.6% vs 6.5%; P = .0077). Among symptomatic women, the presence of renal disease, coronary artery disease, or age ≥80 years increased the risk of CAS over CEA threefold for the composite end point of stroke or death. For asymptomatic women only in those with coronary artery disease or diabetes, there was a statistical difference in the composite mortality/stroke rates favoring CEA (1.9% vs 3.3% and 1.7% vs 3.4%, respectively). After adjusting for relevant clinical and demographic risk factors and hospital annual volume, for CAS vs CEA, the risk of the composite end point of stroke or mortality was 1.7-fold higher in symptomatic and 3.4-fold higher in asymptomatic patients. Medicaid insurance, symptomatic patient, history of cancer, and presence of heart failure on admission were among other strong predictors of composite stroke/mortality outcome.
Databases reflecting real-world practice performance and management of carotid disease in women suggest that CEA compared with CAS has overall better perioperative outcomes in women. Importantly, CAS is associated with significantly higher morbidity in certain clinical settings and this should be taken into account when choosing a revascularization procedure.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 05/2012; 56(2):334-42. · 3.52 Impact Factor
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ABSTRACT: To review a single-center experience with elective coil embolization of splenic artery aneurysm (SAA) and analyze efficacy of the technique at midterm follow-up.
From 2002 through 2011, 50 patients (28 women, 22 men; age range, 24-89 y; mean age, 53.5 y ± 13.6) underwent transcatheter coil embolization for treatment of SAAs. Pseudoaneurysms and ruptured aneurysms were excluded. A total of 63 SAAs were treated (size, 13-97 mm; mean, 29 mm). Ninety-eight percent of aneurysms were treated with coils alone. Regular follow-up consisted of an office visit and imaging. Patient medical records were reviewed for aneurysm location, procedural approach, and technical and clinical outcomes.
Ninety-eight percent of procedures were technically successful at thrombosing the aneurysm at the time of procedure. Repeat intervention was performed in four of 47 patients (9%) because of continued aneurysm perfusion at follow-up. Mean time to repeat intervention was 125 days (range, 42-245 d). All repeat interventions were technically successful. Neither aneurysm growth nor aneurysm rupture was observed in any patient during the follow-up period (mean, 78 weeks; range, 9 d to 7.1 y). There were no major adverse events. Major splenic infarction occurred in three of 33 patients (9%) with no underlying liver disease and normal splenic volume and in seven of 14 patients (50%) with portal hypertension.
Percutaneous transcatheter coil embolization is a safe, effective, and minimally invasive treatment for SAAs as evidenced by high rates of technical success and freedom from aneurysm rupture.
Journal of vascular and interventional radiology: JVIR 05/2012; 23(7):893-9. · 1.81 Impact Factor
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ABSTRACT: We sought to determine the effects of open (O) and closed (C) cell stents on the size and number of embolic particles generated during carotid artery stenting (CAS) and assess the impact on outcome.
Embolic debris from carotid filters after CAS was analyzed using photomicroscopy and imaging software. Patient comorbidities, preoperative cerebrovascular symptoms, stent type, and outcomes (perioperative major adverse events) were examined.
Carotid filters from 173 consecutive CAS procedures (O, 125 and C, 48) were reviewed. The mean age was 70.9 ± 9.2 years; 58% were men. Mean stenosis was 88.2% ± 8.1%; 36.6% had neurological symptoms preprocedurally. There was no difference in preoperative symptoms between the two groups (O, 38.7% vs C, 31.3%; P = not significant [NS]). However, closed cell stent use was associated with higher degree of stenosis (O, 87.2% ± 8.0% vs C, 90.6% ± 7.8%; P = .01), an older age (O, 70.0 ± 8.6 years vs C, 73.4 ± 10.2 years; P = .03), and peripheral arterial disease (21.1% vs 43.5%; P = .01). A larger mean particle size was observed in patients treated with open cell stents compared to closed cell stents (O, 416.5 ± 335.7 μm vs C, 301.1 ± 251.3 μm; P = .03). There was no significant difference in the total number of particles (O, 13.8 ± 21.5 vs C, 17.6 ± 19.9; P = NS), periprocedural stroke (P = NS), and major adverse events between the two groups (P = NS).
Open cell stents are associated with a larger mean particle size compared to closed cell stents. No impact on procedural outcomes based on stent type was observed.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 03/2012; 56(1):89-95. · 3.52 Impact Factor
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ABSTRACT: Carotid angioplasty and stenting (CAS) is an alternative to carotid endarterectomy. CAS outcomes and risk factors affecting postoperative complications in women are not well defined. We sought to determine the effect of sex on particle size captured by embolic protection devices, comorbidities influencing embolization, and results after CAS.
Embolic debris from 188 consecutively collected carotid embolic protection devices were analyzed using photomicroscopy and imaging software. Patient comorbidities, preoperative cerebrovascular symptoms, and perioperative outcomes (cerebrovascular accident, myocardial infarction, mortality) were examined.
The mean age was 71.0 years (56.4% males). Men (M) were more likely than women (W) to be smokers (M: 70.4% vs. W: 55.6%, p = 0.046) and have coronary artery disease (M: 65.7% vs. W: 48.1%, p = 0.02). Symptomatic (S) patients had larger mean particle size compared with asymptomatic (AS) patients (S: 469.9 ± 416.4 μm vs. AS: 316.1 ± 241.1 μm, p = 0.01). On subgroup analysis, a larger mean particle size was observed in symptomatic woman compared with asymptomatic women (S: 461.5 ± 348.1 μm vs. AS: 281.4 ± 209.4 μm, p = 0.02). In men, a trend toward a larger mean particle size in symptomatic patients did not reach statistical significance (S: 475.8 ± 462.9 μm vs. AS: 351.2 ± 262.4 μm, p = 0.08).
Preoperative cerebrovascular symptoms are associated with a greater mean particle size in symptomatic women compared with asymptomatic women. This difference in mean particle size was not observed in men. These results provide evidence that may help in better selection of CAS patients, but the impact of an increased mean particle size in symptomatic women during carotid stenting requires further investigation.
Annals of Vascular Surgery 01/2012; 26(1):93-101. · 1.03 Impact Factor
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ABSTRACT: Crossed-fused renal ectopia is a rare anomaly that poses a therapeutic challenge in the management of abdominal aortic aneurysms (AAAs). Such challenges include preservation of renal blood flow in the setting of multiple aberrant renal arteries and ureteral anomalies. Several surgical approaches to this dilemma, including the use of traditional surgical techniques, have been described in the literature. We describe a novel approach to the management of a 7-cm inflammatory AAA associated with crossed renal ectopia with fusion.
During routine surveillance computed tomography angiography (CTA) in a 63-year-old man, a rapidly enlarging AAA with new inflammatory changes was detected. The aneurysm had increased in size from 4.8 to 7 cm over a period of 6 months. At the time of presentation, he was found to be hemodynamically stable. Findings from the laboratory tests conducted at the time of admission were normal, with a baseline glomerular filtration rate of 91.2 mL/min and creatinine of 1. The CTA revealed significant thickening of the aortic wall, suggestive of aortic inflammation, the presence of crossed renal ectopia with fusion, and numerous anomalous renal arteries. We identified two right renal arteries arising from the proximal aneurysm sac and three left renal arteries arising from the common iliac arteries. Given the aortic inflammation, an open repair approach was considered high risk compared with an endovascular aneurysm repair (EVAR). However, given the uncharacteristic arterial anatomy, a staged surgical and endovascular management option was selected. We performed an aortic debranching and renal artery revascularization, followed by an EVAR.
We preserved renal function and excluded the aneurysm. The patient was discharged on the postoperative day 6 without periprocedural complications. A CTA was performed at 1- and 6-month follow-up period. This revealed a type 2 endoleak, which was confirmed by MR angiography. However, the aneurysm diameter had decreased in size from 7 to 6.3 cm in 1 month, and from 6.3 to 5.5 cm in 6 months. No further intervention was performed.
Inflammatory AAAs associated with crossed-fused renal ectopia can be successfully managed with aortic debranching and renal artery revascularization followed by an EVAR. This epitomizes the growing role for advanced endovascular therapies in conjunction with open surgical techniques.
Annals of Vascular Surgery 08/2011; 25(7):984.e9-14. · 1.03 Impact Factor
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ABSTRACT: Historically, women have higher procedurally related mortality rates than men for abdominal aortic aneurysm (AAA) repair. Although endovascular aneurysm repair (EVAR) has improved these rates for men and women, effects of gender on long-term survival with different types of AAA repair, such as EVAR vs open aneurysm repair (OAR), need further investigation. To address this issue, we analyzed survival in matched cohorts who received EVAR or OAR for both elective (eAAA) and ruptured AAA (rAAA).
Using the Medicare Beneficiary Database (1995-2006), we compiled a cohort of patients who underwent OAR or EVAR for eAAA (n = 322,892) or rAAA (n = 48,865). Men and women were matched by propensity scores, accounting for baseline demographics, comorbid conditions, treating institution, and surgeon experience. Frailty models were used to compare long-term survival of the matched groups.
Perioperative mortality for eAAAs was significantly lower among EVAR vs OAR recipients for both men (1.84% vs 4.80%) and women (3.19% vs 6.37%, P < .0001). One difference, however, was that the survival benefit of EVAR was sustained for the 6 years of follow-up in women but disappeared in 2 years in men. Similarly, the survival benefit of men vs women after elective EVAR disappeared after 1.5 to 2 years. For rAAAs, 30-day mortality was significantly lower for EVAR recipients compared with OAR recipients, for both men (33.43% vs 43.70% P < .0001) and women (41.01% vs 48.28%, P = .0201). Six-year survival was significantly higher for men who received EVAR vs those who received OAR (P = .001). However, the survival benefit for women who received EVAR compared with OAR disappeared in 6 months. Survival was also substantially higher for men than women after emergent EVAR (P = .0007).
Gender disparity is evident from long-term outcomes after AAA repair. In the case for rAAA, where the long-term outcome for women was significantly worse than for men, the less invasive EVAR treatment did not appear to benefit women to the same extent that it did for men. Although the long-term outcome after open repair for elective AAA was also worse for women, EVAR benefit for women was sustained longer than for men. These associations require further study to isolate specific risk factors that would be potential targets for improving AAA management.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 04/2011; 54(1):1-12.e6; discussion 11-2. · 3.52 Impact Factor
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ABSTRACT: Despite overall improvement, there is still a gender-related disparity in the outcomes of lower extremities peripheral arterial disease (PAD). We analyzed sex-related variability among factors that are known to influence outcomes.
Data on PAD inpatient hospitalizations from New York, New Jersey, and Florida state hospital discharge databases (1998-2007) were analyzed using univariate and multivariate logistic regression analyses.
Of the 372,692 surgical hospitalizations identified, 162,730 (43.66%) involved women. Men and women undergoing vascular procedures differed in that more men smoked (18% vs 14%; P<.0001), and more men had coronary artery disease (40% vs 33%; P<.0001). Women were more likely to be obese (11.86% vs 4.89%; P<.0001), black (18.81% vs 12.66%; P<.0001), older, and have critical limb ischemia (CLI) (39.41% vs 37.67%; P<.0001). They had higher mortality (5.26% vs 4.21%; P<.0001) and complication rates, especially bleeding (10.62 % vs 8.19%; P<.0001) and infection (3.23% vs 2.88%; P<.0001). Mortality rates after endovascular procedures were lower and showed marginal difference between genders (2.87% vs 2.11%; P<.0001). The difference was more pronounced after open revascularizations (5.05% for women vs 4.00% for men; P<.0001) and amputations (9.82% for women vs 8.82% for men; P<.0001). Bleeding differences between men and women were greatest when both open and endovascular procedures were done during the same hospitalizations and lowest after major amputations. Similar to bleeding, transgender differences in postoperative infections were more pronounced after combination of open and endovascular procedures. Using a multivariable model, female gender remained a predictor of perioperative mortality, infection, and bleeding after vascular intervention (odds ratios 1.15, 1.21, and 1.32, respectively). Female gender negatively influenced the mortality of patients with cerebrovascular and coronary disease and those of black race even after adjusting for relevant clinical and demographic risk factors. Gender effect on mortality dissipated in octogenarians and patients with claudication.
Female gender continues to be an important risk factor that negatively influences the outcomes of vascular interventions; however, these effects vary between different high-risk groups and procedures. Gender effect on mortality dissipates in elderly patients. Prompt recognition of the associations between gender and various risk factors of cardiovascular disease and aggressive modification of these risk factors in female patients may improve gender-related disparity in the outcomes of vascular disease.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 11/2010; 52(5):1196-202. · 3.52 Impact Factor
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ABSTRACT: Advances in technology and practice have led to increased endovascular management of all TransAtlantic Society Consensus (TASC)-graded lesions. This study aims to evaluate the success of endovascular therapy in the management of TASC-graded femoropopliteal lesions.
Patients undergoing endovascular treatment for femoropopliteal lesions between July 1999 and August 2008 were divided by TASC scores and evaluated for primary, assisted-primary, and secondary patency rates at 12 and 24 months. Secondary endpoints included limb loss and postoperative complications.
A total of 499 femoropopliteal lesions in 427 patients were treated with endovascular interventions. Score distribution for TASC type A, type B, type C, and type D lesions was 26 (5.2%), 140 (28.1%), 168 (33.7%), and 165 (33.1%), respectively. Primary, assisted-primary, and secondary patency rates at 24 months were 77.7 ± 3.2%, 78.9 ± 3.2%, and 86.7 ± 2.6%, respectively, for TASC type A + B lesions, 76.0 ± 3.3%, 77.2 ± 3.2%, and 85.0 ± 2.8%, respectively, for TASC type C lesions, and 61.2 ± 3.8%, 61.2 ± 3.8%, and 78.2 ± 3.2%, respectively, for TASC type D lesions. Compared with TASC type A + B and TASC type C lesions, TASC type D lesions were associated with worse primary and assisted-primary patency rates. However, there was no statistically significant difference in secondary patency between TASC type A + B and TASC type D lesions. The TASC score was not a significant predictor of postoperative complication rates. The 24-month limb salvage rate in patients with TASC type D lesions presenting with critical limb ischemia was 71.9 ± 8.0%.
It was observed that all femoropopliteal lesions can be safely and effectively managed with endovascular therapy. Although TASC type D lesions do have lower primary and assisted-primary patency rates, high secondary patency rates comparable with other TASC scores can be achieved with effective prevention of limb loss. These data provide evidence to support endovascular therapy as primary management for all femoropopliteal lesions regardless of the TASC score.
Annals of Vascular Surgery 10/2010; 25(1):15-24. · 1.03 Impact Factor
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ABSTRACT: Gender-related differences continue to challenge the management of lower extremity (LE) peripheral arterial disease (PAD) in women. We analyzed the time-trends in hospital care of such differences.
Data for patients with PAD from New York, New Jersey, and Florida state hospital inpatient discharge databases (1998-2007) were analyzed using univariate and multivariate regression analyses.
The 2.4 million PAD-related inpatient discharge records analyzed showed a slight decrease of inpatient procedures for both genders. Compared with men, women had 18% to 27% fewer PAD and 33% to 49% fewer vascular procedural hospitalizations (P < .0001). They were persistently more likely than men to be admitted emergently (56% vs 51% in 1998 and 57% vs 53% in 2007) and discharged to a nursing home. During the study period, the amputation rate declined by 36% in women and 21% in men with PAD, and similarly, open procedures decreased by 36% and 30%. Endovascular procedures, however, increased by 150% in women and 144% in men. Procedural mortality was 4.95% vs 4.37% for men (P < .0001). Female mortality rates were persistently higher after amputations (9.89% vs 8.90%, P < .0001), open (5.49% vs 4.00%, P < .0001), and endovascular procedures (2.87% vs 2.10%, P < .0001). Time trends showed improved mortality for men and women, with a stable difference between the two.
The analysis of representative state administrative databases of inpatient care records demonstrated improvements in mortality and amputation rates over time. However, a gender-related disparity in PAD outcomes remains that merits further investigation.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 12/2009; 51(2):372-8.e1; discussion 378-9. · 3.52 Impact Factor
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ABSTRACT: Persistent sciatic artery (PSA) is a rare vascular anomaly present in 0.025% to 0.05% of the population. They are particularly prone to aneurysmal degeneration, potentially leading to distal ischemia, sciatic neuropathy, or rarely rupture. Here, we describe a case of a ruptured PSA aneurysm managed by endovascular embolization. A 70-year-old man initially presented with acute left lower extremity ischemia. He was found to have a popliteal embolus originating from a complete persistent sciatic artery aneurysm. He underwent thrombolysis followed by a femoropopliteal bypass and ligation of the proximal popliteal artery to exclude the PSA. Four weeks later he re-presented with severe pain, a pulsatile buttock mass, and anemia in the setting of hemodynamic instability. A ruptured PSA aneurysm was confirmed by computed tomography angiography (CTA). This was managed emergently by endovascular exclusion of the inflow and outflow vessels using Amplatzer vascular plugs. His postoperative course was complicated by both a foot drop, likely secondary to sciatic nerve ischemia, and a buttock abscess. To our knowledge, this is the first report detailing the endovascular management of a ruptured PSA aneurysm. The etiology, management, and complications associated with the treatment of this rare vascular entity are discussed.
Annals of Vascular Surgery 11/2009; 24(1):115.e5-9. · 1.03 Impact Factor
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ABSTRACT: Despite several reports of proximal arm ischemia due to radiation therapy, there are no reports of hand ischemia, presumably due to the rarity of radiation treatment of the distal upper extremity. We present a case of a 42-year-old male presenting with acute hand ischemia 36 years after being treated with forearm radiation for Ewing's sarcoma. Angiography demonstrated a patent brachial artery, occluded radial and ulnar arteries in the forearm, and a normal-caliber reconstituted radial artery at the anatomical snuffbox feeding a patent palmar arch. Transluminal balloon angioplasty was attempted initially without improvement. The patient was successfully revascularized with a reversed saphenous vein graft bypass from the distal brachial artery to the distal radial artery. At 22 months of follow-up, the graft remains patent with a palpable distal pulse. The patient continues to report acceptable function and range of motion.
Annals of Vascular Surgery 11/2009; 24(2):257.e5-8. · 1.03 Impact Factor
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ABSTRACT: Historically, large randomized controlled studies looking at carotid endarterectomy (CEA) have indicated an increased perioperative risk for women when gender subgroup analysis was performed. However, the outcomes of carotid stenting in women as compared to men have not been adequately investigated. We sought to compare the safety and efficacy of carotid angioplasty and stenting (CAS) when performed in women as compared to men.
Procedures, complications, demographics, co-morbidities, and follow-up data from carotid stenting procedures performed in a bi-campus division were entered into a prospective database and then retrospectively supplemented with stored angiographic image data and reviewed. Arterial anatomic characteristics evaluated using angiographic images were: common carotid/internal carotid lesion length ratio, common carotid/internal carotid diameter, index lesion length, common carotid/internal carotid artery tortuosity, and lesion and aortic arch calcification. Outcomes compared included groin complications, postoperative pressor requirements, length of stay, restenosis, stroke, myocardial infarction (MI), and death.
Between 2003 and 2008, 228 patients underwent 238 procedures. Cerebral protection devices and self-expanding stents were placed in all patients. A total of 97 percutaneous interventions performed in 93 women were compared with 141 interventions in 135 men. Mean age in women was 71.8 +/- 9.2 years, in men was 72.2 +/- 9.1 years (P > .99); 44.3% of women and 34.7% of men had symptomatic disease (P = .14). Preoperative demographics and co-morbidities did not differ significantly between genders, with the exception of hypertension (83.0% of males vs 96.7% of females, P = .001), and history of coronary artery bypass grafting (31.8% of males vs 16.1% of females, P = .01). There were no significant differences seen in anatomic arterial characteristics, though there was a trend towards women having larger internal carotid to common carotid diameter ratios (0.65 vs 0.62) and more plaques isolated to the common carotid segment (9.5% vs 6.9%). There were no significant differences seen in overall 30-day peri-procedural stroke rate (2.1% in women and 4.2% in men, P = .48), death rate (0 % vs 0.7%, P > .99), or cardiac events (3.2% vs 0.7%, P = .3). The combined 30-day stroke, death, and MI rate was 5.7% for males compared to 5.4% for females (P > .99). There were no differences observed in the long-term survival, stroke-free survival, or restenosis between genders.
Despite previous concerns over adverse outcomes in women undergoing carotid endarterectomy, from our data, carotid stenting appears to be a safe modality in women with equivalent outcomes when compared to men.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 02/2009; 49(2):315-23; discussion 323-4. · 3.52 Impact Factor
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ABSTRACT: Arterial disease in women will become a major issue in the near future.
A systemic review of existing literature was retrospectively conducted to collect information on the three most common entities of vascular disease: carotid atherosclerotic, abdominal aortic aneurismal, and lower extremity arterial occlusive disease.
Vascular disease is either underdiagnosed or undertreated in women. Whether regarding cerebrovascular disease, aortic aneurysmal disease, or atherosclerosis affecting the lower extremities, natural history, clinical and physiologic patterns are different in women vs men. Current biomedical devices create challenges in endovascular procedures performed in women. Furthermore, indications for treatment of vascular disease are derived from large studies where women are often underrepresented; and, thus, may not be applicable in female vascular patients.
Better understanding of the gender differences in vascular disease with focused randomized trials, biomedical research, and identification of gender specific medical and social risk factors will improve the clinical outcomes in female patients.
Journal of Vascular Surgery 01/2008; 46(6):1295-302. · 3.21 Impact Factor
