Association of sex with patency of femorodistal bypass grafts

Objective: there is evidence for superior patency in infra-inguinal bypass procedures in men compared to women. A large, prospectively planned series was investigated in order to confirm this finding and to determine the orig in of this difference in outcome. Methods: patients underwent femorodistal bypass surgery and a prospectively planned 12-month follow-up. Outcomes in male and female patients were comp ared and investigated for associations with characteristics of the patients and the surgical procedures. Results: a total of 517 patients received femorodistal bypass grafts, inclu ding 424 vein grafts and 93 prosthetic and vein-prosthetic composite grafts . Patency was confirmed to be higher in male that in female patients (56% v s. 42%, p = 0.005). Fewer male patients received prosthetic or composite gr afts (21% vs. 33%, p = 0.005), but the difference in patency was evident on ly in patients receiving vein grafts. Female patients were smaller, include d fewer smokers (p<0.001) and had worse symptoms (p=0.03), but none of thes e characteristics explained the difference in outcome. Patency in vein graf ts was associated with graft diameter (p=0.004), but graft diameter was not significantly associated with sex (p=0.09) or with body size. Conclusions: it was confirmed that patency of femorodistal bypasses is sign ificantly higher in males than females. None of the factors investigated he re explain this difference, but the greater use of prosthetic and composite grafts in female patients suggests that poorer vein quality should be inve stigated as a possible source of the inferior outcome in female patients.