THE IMPACT OF GENDER ON THE RESULTS OF ARTERIAL BYPASS WITH IN-SITU GREATER SAPHENOUS-VEIN

BACKGROUND: This 10-year review of in situ saphenous vein bypass surge ry was undertaken to assess the impact of gender on infrainguinal arte rial reconstruction. PATIENTS AND METHODS: From March 1983 to March 19 93, the results of 244 in situ saphenous vein bypasses performed in wo men were compared with 338 performed in men. Women were older than men (78.9 versus 66.8 years; P < 0.001) and had a higher incidence of hyp ertension but a lower incidence of coronary artery disease, smoking hi story, and chronic obstructive pulmonary disease. The primary indicati on for surgery was limb salvage for both genders (women 70.1%, men 68% ; P = not significant [NS]). Men had bypasses to more-distal outflow v essels, with 52.5% to the tibial level compared with 42.2% of women (P < 0.003). RESULTS: Women had lower perioperative mortality rates than men (0.8% versus 3.3%; P < 0.025) and a similar incidence of major co mplications (6.6% versus 7.7%; P = NS), but a higher incidence of sign ificant wound complications (13.5% versus 3.3%; P < 0.001). Life-table evaluation at 10 years after surgery showed no significant difference s between women and men in primary graft patency rate (67.8% versus 58 .2%; P = NS), secondary patency rate (73.5% versus 77;2%; P = NS), lim b salvage rate (87.9% versus 92%; P = NS) or patient survival rate (35 .5% versus 24.4%; P = NS). For bypasses to the tibial arteries, graft patency rates were slightly inferior for women (69.8% versus 81.1%, 5- year secondary patency rate; P < 0.008). Similarly, in bypasses perfor med for limb salvage, women had lower 5-year primary patency rates tha n men (60.3% versus 70.3%; P < 0.002). Secondary patency rates in this limb salvage group however, did non differ (75.5% versus 82.8%; P = N S) CONCLUSIONS: Despite small gender differences in the results of in situ bypass grafts for limb salvage and those carried to the tibial le vel, women had the same overall patency, limb salvage, and survival ra tes as men after infrainguinal bypass surgery Treatment of infrainguin al occlusive disease should not vary based on inaccurate perceptions c oncerning differences in surgical results for men and women.