Challenges associated with peripheral arterial disease in women

Figures & data

Table 1 Concomitant conditions that may pose a challenge associated with peripheral arterial disease (PAD) detection or management, particularly in women

Coronary and carotid artery disease

Coexistence with PAD less frequent in women than in men

Depression

Fourfold-greater odds for baseline depression in women diagnosed with PAD than in men

Orthopedic diseases

Higher prevalence of orthopedic diseases in subjects with PAD, which are also associated with female sex

Osteoporosis

Age-dependent association between PAD and osteoporosis in women, but not in men

Hypothyroidism

Increased prevalence of symptomatic PAD among subjects with subclinical hypothyroidism, an entity typically associated with female sex

Use of oral contraceptives

Oral contraceptives may increase the risk of PAD

History of complications during pregnancy

Adverse pregnancy outcomes independently associated with atherothrombotic occlusive vascular disease, including PAD

Hormone-replacement therapy (HRT)

In women undergoing iliac angioplasty and stenting, HRT significantly reduced 5-year primary patency rates

Table 2 Diagnostic methods in peripheral arterial disease: sex-related challenges

Method	Challenge
ABI	Concerns raised regarding the need for different cutoff values in women
	Conditions related to stiff arteries (older age, diabetes) more frequent in women with PAD
Duplex ultrasound	Difficulty in assessing the lumen in the presence of highly calcified arteries, a phenomenon more frequently observed in women
	Not useful for areas of open ulcers or excessive scarring, typical of advanced disease, more frequently encountered in women
	Accuracy diminished in proximal aortoiliac arterial segments in the context of obesity with peripheral fat distribution, more common in women
CT, MRA, and contrast angiography	Claustrophobia precluding MRA tolerance more common in women
	Iodinated contrast allergy more frequent in women

Abbreviations: ABI, ankle-brachial index; CT, computed tomography; MRA, magnetic resonance angiography; PAD, peripheral arterial disease.

Figure 1 Management challenges associated with peripheral arterial disease in women: cardiovascular risk reduction.

Abbreviations: ACE-I, angiotensin-converting enzyme inhibitor; CV, cardiovascular; PAD, peripheral arterial disease.

Figure 2 Treatment for symptomatic peripheral arterial disease: sex-related challenges.

Abbreviation: PAD, peripheral arterial disease.