Background
Peripheral arterial disease occurs in 20% of patients over age 65 (more common in men). Peripheral vascular intervention (PVI) is associated with increased radiation using standard dose radiation (SDR). No study has evaluated the outcomes of women versus (vs.) men undergoing PVI using minimal dose radiation (MDR) vs. SDR.
Methods
We performed a prospective observational study of 186 patients (65+12 years, mean follow-up of 4 months) at a university hospital from January 2019 to April 2020 and compared the outcomes of women (n=99, 53.2%) vs. men (n=87, 46.8%) undergoing PVI for critical limb/acute limb ischemia using MDR (n=24, 12.9%) vs. SDR (n=162, 87.1%). MDR utilized 0.5-1.0 frames/second (f/s) fluoroscopy and 7.5 f/s cine angiography. SDR used
> 7.5 f/s fluoroscopy and cine angiography. Primary endpoints included fluoroscopy time, dose area product (DAP), air kerma, and contrast use. Secondary endpoints included acute kidney injury, myocardial infarction, repeat revascularization, vessel dissection/perforation, and total complications.
Results
In men, DAP (15221.2
+25858.5 µGy*m
2) was significantly greater than women (9251.7
+9555.3 µGy*m
2; p=0.047). No significant difference was found between women vs. men in fluoroscopy time (24.1
+16.3 vs. 30.2
+25.6 minutes, p=0.34), air kerma (474.8
+493.2 vs. 616.8
+1101.8 mGy, p=0.38), and contrast use (98.4
+57.5 vs. 106.1
+62.1 mL, p=0.48). In the secondary outcomes, no significant difference was found between women vs. men in the incidence of acute kidney injury (17% vs. 9%), myocardial infarction (1% vs. 3%), repeat vessel revascularization (8% vs. 14%), or total complications (21% vs. 20%). MDR compared with SDR showed a significant reduction in the primary radiation endpoints (p<0.001) with significantly lower complications (n=1, 4.2%; n=37, 22.8%; p=0.034).
Conclusions
Gender outcomes of PVI showed a significant increase in DAP in men. None of the secondary endpoints differed between gender. MDR significantly diminished the primary radiation endpoints compared with SDR without increased complications.