Disparities in Sex-Based Health Outcomes of Endovascular Intervention for the Treatment of Symptomatic Lower Extremity Peripheral Artery Disease: A Scoping Review

Abstract

Abstract

Peripheral artery disease (PAD) is a chronic vascular condition that affects millions of individuals worldwide and is a significant burden on public health. Although female subjects may be at greater risk of developing PAD owing to sex-specific risk factors and frequently present with atypical symptoms, diagnosis rates are comparable between women and men. Treatment of PAD commonly relies on endovascular interventions, including angioplasty, stenting, and atherectomy. While these interventions have proven effective, understanding sex-specific differences in outcomes has been insufficiently studied. This scoping review was conducted to assess the health outcomes of endovascular interventions for PAD in female subjects residing in the United States (US). A systematic search was performed across multiple databases, including EMBASE, Ovid MEDLINE, and Web of Science. The inclusion criteria focused on studies published between 2016 and 2024, involving lower extremity PAD interventions across the US female populations. Studies evaluating non-US populations, pharmacological treatments, and asymptomatic individuals were excluded. Data extraction focused on key factors, including (1) complication rates, (2) need for reintervention, and (3) long-term health outcomes. Nine retrospective cohort studies met the inclusion criteria. We analyzed complications, reintervention rates, amputation risks, and mortality outcomes, revealing variation in findings. Five studies reported increased complications in female patients, such as arterial dissection and hematoma formation. Additionally, four studies showed higher rates of reintervention among female patients, while one found no significant sex-based differences in reintervention or complications. Similarly, while three studies identified a greater risk of amputation and mortality in female patients, two others revealed no disparities or better outcomes among female patients. The variability in outcome measures, study designs, and patient populations may have contributed to the inconsistencies across these findings. These varied findings highlight the need for more standardized research measures to accurately assess how sex-based differences impact PAD treatment outcomes. Further research is necessary to explore anatomical, physiological, and sociocultural factors contributing to these disparities and to improve treatment strategies for female patients with PAD.