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Peripheral artery disease (PAD) affects a growing number of women, with a prevalence equal to that of men. Still, little is known about sex-specific differences in disease manifestations of PAD and how these differences in presentation impact outcomes of surgical and endovascular intervention. Women have also been consistently underrepresented in clinical trials evaluating treatment options for vascular disease. Thus, many of the practice guidelines in place today were generated from clinical trial data that either included a small number of women or excluded them entirely, and, consequently, whose findings may not be applicable to female patients. This review discusses key differences in outcomes based on sex for intervention of lower extremity, carotid, and abdominal aortic aneurysmal (AAA) disease. Elucidating sex-specific differences in disease manifestation and outcomes will provide insight into ways to optimize patient care, particularly for women afflicted with vascular disease. [ABSTRACT FROM AUTHOR]

The impact of heart failure (HF) on long-term survival in patients with critical limb ischemia (CLI) has not been well described. Outcomes stratified by left ventricular ejection fraction (EF) are also unknown. A single center retrospective chart review was performed for patients who underwent treatment for CLI from 2006 to 2013. Baseline demographics, procedural data and outcomes were analyzed. HF diagnosis was based on appropriate signs and symptoms as well as results of non-invasive testing. Among 381 CLI patients, 120 (31%) had a history of HF and 261 (69%) had no history of heart failure (no-HF). Within the HF group, 74 (62%) had HF with preserved ejection fraction (HFpEF) and 46 (38%) had HF with reduced ejection fraction (HFrEF). The average EF for those with no-HF, HFpEF and HFrEF were 59±13% vs 56±9% vs 30±9%, respectively. The likelihood of having concomitant coronary artery disease (CAD) was lowest in the no-HF group (43%), higher in the HFpEF group (70%) and highest in the HFrEF group (83%) (p=0.001). Five-year survival was on average twofold higher in the no-HF group (43%) compared to both the HFpEF (19%, p=0.001) and HFrEF groups (24%, p=0.001). Long-term survival rates did not differ between the two HF groups (p=0.50). There was no difference in 5-year freedom from major amputation or freedom from major adverse limb events between the no-HF, HFpEF and HFrEF groups, respectively. Overall, the combination of CLI and HF is associated with poor 5-year survival, independent of the degree of left ventricular systolic dysfunction. [ABSTRACT FROM AUTHOR]

Ankle-brachial indices (ABIs) are important for the assessment of disease burden among patients with peripheral artery disease. Although low values have been associated with adverse clinical outcomes, the association between noncompressible ABI (ncABI) and clinical outcome has not been evaluated among patients with critical limb ischemia (CLI). The present study sought to compare the clinical characteristics, angiographic findings and clinical outcomes of those with compressible (cABI) and ncABI among patients with CLI. Consecutive patients undergoing endovascular evaluation for CLI between 2006 and 2013 were included in a single center cohort. Major adverse cardiovascular events (MACE) were then compared between the two groups. Among 284 patients with CLI, 68 (24%) had ncABIs. These patients were more likely to have coronary artery disease (p=0.003), diabetes (p<0.001), end-stage renal disease (p<0.001) and tissue loss (p=0.01) when compared to patients with cABI. Rates of infrapopliteal disease were similar between the two groups (p=0.10), though patients with ncABI had lower rates of iliac (p=0.004) or femoropopliteal stenosis (p=0.003). Infrapopliteal vessels had smaller diameters (p=0.01) with longer lesions (p=0.05) among patients with ncABIs. After 3 years of follow-up, ncABIs were associated with increased rates of mortality (HR 1.75, 95% CI: 1.12-2.78), MACE (HR 2.04, 95% CI: 1.35-3.03) and major amputation (HR 1.96, 95% CI: 1.11-3.45) when compared to patients with cABIs. In conclusion, ncABIs are associated with higher rates of mortality and adverse events among those undergoing endovascular therapy for CLI. [ABSTRACT FROM AUTHOR]