Background: Peripheral arterial disease (PAD) is on the rise, with a growing prevalence in an aging population and increasing rates of diabetes. Chronic limb threatening ischemia (CLTI) poses a significant risk of limb loss. PAD is common in women, particularly after menopause, with a 35% prevalence rate in women over the age of 65. Studies have suggested that women have inferior outcomes compared to men after endovascular revascularization for PAD. With the rising utilization of endovascular interventions for the treatment of PAD, we sought to perform a review of gender-based outcomes of peripheral endovascular interventions for the treatment of symptomatic PAD.

Methods: A scoping literature review was conducted to evaluate the outcomes of female patients undergoing endovascular peripheral interventions for PAD. Eligibility criteria included studies focusing on adult women with lifestyle limiting claudication (LLC) or chronic limb threatening ischemia (CLTI) who underwent endovascular intervention. Various endovascular procedures were considered, and outcomes of interest included mortality, amputations, re-interventions, bleeding complications, and major adverse cardiac events (MACE). A systematic search was conducted in PubMed, Embase, Web of Science, and Cochrane databases.

Results: Sixteen studies were included in the review. Female patients undergoing endovascular interventions were associated with bleeding complications, higher rates of re-intervention, and a risk of non-fatal strokes. However, female gender was not linked to higher rates of amputation or conclusively higher mortality rates post-intervention.

Conclusion: The comprehensive scoping review reveals important gender-related disparities in outcomes after endovascular procedures for symptomatic PAD. Female patients have been reported to experience worse outcomes in terms of re-interventions and bleeding complications. These findings emphasize the need for future trials specifically focusing on female patients to develop gender-inclusive treatment recommendations for advanced peripheral arterial disease.