Restenoses, either due to development of the underlying disease or intimal hyperplasia, are the key determinants of the long-term outcome of percutaneous transluminal angioplasties. On the one hand, pharmacological compounds and, on the other, the implantation of stents have both been developed with the goal of preventing this condition. While patients are treated with various low-molecular-weight heparins after PTA of peripheral arteries, the indication for stent implantation is chosen on an individual basis rather than based on experience. The relevance of risk variables in long-term outcomes following PTA has been studied infrequently. The goal of this research was to find gender-specific risk variables for long-term outcomes following percutaneous transluminal angioplasty (PTA) of peripheral arteries with or without stent placement.
Methods: The long-term effects of percutaneous transluminal angioplasty (PTA) of peripheral arteries were investigated in this study.
In our clinic, 3,276 patients had PTA with or without stent placement between 2007 and 2017. All patients were given 25,000 IU heparin (Unfractionated Heparin (UFH), heparinsodium-Braun, 25,000 I.E./5 ml, 2 ml/h) 48 hours after the procedure, which was tracked by the partial thromboplastin time, and then had a follow-up investigation every 6 months. The study's endpoint was the detection of symptomatic stenosis greater than 50% that needed reintervention.
Results: Complete follow-up was performed on 239 male patients (68.2%, mean age 68.02 years) and 111 female patients (31.71 percent, mean age 62.92 years). In numerous interventions, 470 PTAs were conducted on male patients and 213 on female patients. According to Fontaine's classification, the majority of patients were in stage IIb at the time of treatment (81.6 percent of male patients and 68 percent of females). Peripheral artery disease stages III and IV, according to the Fontaine classification, were twice as common in female patients as in male patients in our study (stage III in 12.6 percent in female versus 6.1 percent in male, and stage IV in 18 percent in female versus 8.9 percent in males). The femoral superficialis artery was the most often dilated in both groups (64 instances in females and 155 cases in males), followed by the iliacal communis artery (46 cases in female and 99 cases in male, both with 21.5 percent ). Female patients had a balloon angioplasty of the tibialis anterior and posterior arteries twice as often as male patients (28 cases with 13.1 percent of tibialis ant. artery in female versus 32 cases with 6.8 percent in male patients, and in 17 cases with 7.9 percent of tibialis post. artery in female versus 16 cases with 3.4 percent in male patients). Without taking gender into account, patency rates for PTA without stent implantation were found to be 79 percent after 2.5 years, 67 percent after 5 years, 49 percent after 7.5 years, and 37 percent after 10 years. The cumulative patency rates for stent implantation were 49 percent during the 7th and 10th year of follow-up, compared to 31 percent for PTA alone. The findings of this study reveal that stent-assisted PTAs of the common artery and externaliliacal artery are much more risk-independent than femoral arteries, and that they are better in female patients than male patients. In the long run, stent placement does not benefit male patients considerably. Gender-related findings are particularly obvious for renal insufficiency and diabetes mellitus, and less so for the number of open lower leg vessels, as shown by the COXI and II regression analyses.
Conclusion: While male patients with diabetes mellitus, renal insufficiency, and/or poor run-off did not benefit from stent implantation in the long run, female patients with similar risk factors experienced higher patency rates after stent therapy. Furthermore, in both genders, the long-term effects of PTA of the femoral superficialis and poplitea arteries are much worse than PTA of the pelvic vessels. According to the findings, gender differences are particularly noticeable in renal insufficiency and diabetes mellitus, and less so in the number of open lower leg veins.Author(S) Details
Masoud Mirzaie
Department of Vascular Surgery, OWL University, Campus Lemgo, Rintelner Strae 85, 32657 Lemgo, Germany.
Zaur Guliyev
Department of Vascular Surgery, OWL University, Campus Lemgo, Rintelner Strae 85, 32657 Lemgo, Germany.
Mohammed Dakna
Biostatistics and Bioinformatics, Neurology Clinic, University Medical Center Göttingen, Robert-Koch-Strabe 40, 37075 Göttingen, Germany.
Matthias Schütz
Institute for Interventional Radiology , OWL University, Campus Lemgo, Rintelner Strae 85, 32657 Lemgo, Germany.
Andrea Feddern
Institute for Interventional Radiology , OWL University, Campus Lemgo, Rintelner Strae 85, 32657 Lemgo, Germany.
Marc Thielke
Institute for Interventional Radiology , OWL University, Campus Lemgo, Rintelner Strae 85, 32657 Lemgo, Germany.
Sheila Fatehpur
Department of Vascular Surgery, OWL University, Campus Lemgo, Rintelner Strae 85, 32657 Lemgo, Germany.
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