Sex-Related Differences and Factors Associated with Peri-Procedural and 1 Year Mortality in Chronic Limb-Threatening Ischemia Patients from the CLIMATE Italian Registry
Authors: Martelli Eugenio , Zamboni Matilde , Sotgiu Giovanni , Saderi Laura , Federici Massimo , Sangiorgi Giuseppe M. , Puci Mariangela V. , Martelli Allegra R. , Messina Teresa , Frigatti Paolo , Borrelli Maria Pia , Ruotolo Carlo , Ficarelli Ilaria , Rubino Paolo , Pezzo Francesco , Carbonari Luciano , Angelini Andrea , Galeazzi Edoardo , Di Pinto Luca Calia , Fiore Franco M. , Palmieri Armando , Ventoruzzo Giorgio , Mazzitelli Giulia , Ragni Franco , Bozzani Antonio , Forliti Enzo , Castagno Claudio , Volpe Pietro , Massara Mafalda , Moniaci Diego , Pagliasso Elisa , Peretti Tania , Ferrari Mauro , Troisi Nicola , Modugno Piero , Maiorano Maurizio , Bracale Umberto M. , Panagrosso Marco , Monaco Mario , Giordano Giovanni , Natalicchio Giuseppe , Biello Antonella , Celoria Giovanni M. , Amico Alessio , Di Bartolo Mauro , Martelli Massimiliano , Munaó Roberta , Razzano Davide , Colacchio Giovanni , Bussetti Francesco , Lanza Gaetano , Cardini Antonio , Di Benedetto Bartolomeo , De Laurentis Mario , Taurino Maurizio , Sirignano Pasqualino , Cappiello Pierluigi , Esposito Andrea , Trimarchi Santi , Romagnoli Silvia , Padricelli Andrea , Giudice Giorgio , Crinisio Adolfo , Di Nardo Giovanni , Battaglia Giuseppe , Tringale Rosario , De Vivo Salvatore , Compagna Rita , Tolva Valerio S. , D’Alessio Ilenia , Curci Ruggiero , Giovannetti Simona , D’Arrigo Giuseppe , Basile Giusi , Frigerio Dalmazio , Veraldi Gian Franco , Mezzetto Luca , Ippoliti Arnaldo , Oddi Fabio M. , Settembrini Alberto M. 
Published: February 2023

Background: Identifying sex-related differences/variables associated with 30 day/1 year mortality in patients with chronic limb-threatening ischemia (CLTI). Methods: Multicenter/retrospective/observational study. A database was sent to all the Italian vascular surgeries to collect all the patients operated on for CLTI in 2019. Acute lower-limb ischemia and neuropathic-diabetic foot are not included. Follow-up: One year. Data on demographics/comorbidities, treatments/outcomes, and 30 day/1 year mortality were investigated. Results: Information on 2399 cases (69.8% men) from 36/143 (25.2%) centers. Median (IQR) age: 73 (66–80) and 79 (71–85) years for men/women, respectively (p < 0.0001). Women were more likely to be over 75 (63.2% vs. 40.1%, p = 0.0001). More men smokers (73.7% vs. 42.2%, p < 0.0001), are on hemodialysis (10.1% vs. 6.7%, p = 0.006), affected by diabetes (61.9% vs. 52.8%, p < 0.0001), dyslipidemia (69.3% vs. 61.3%, p < 0.0001), hypertension (91.8% vs. 88.5%, p = 0.011), coronaropathy (43.9% vs. 29.4%, p < 0.0001), bronchopneumopathy (37.1% vs. 25.6%, p < 0.0001), underwent more open/hybrid surgeries (37.9% vs. 28.8%, p < 0.0001), and minor amputations (22% vs. 13.7%, p < 0.0001). More women underwent endovascular revascularizations (61.6% vs. 55.2%, p = 0.004), major amputations (9.6% vs. 6.9%, p = 0.024), and obtained limb-salvage if with limited gangrene (50.8% vs. 44.9%, p = 0.017). Age > 75 (HR = 3.63, p = 0.003) is associated with 30 day mortality. Age > 75 (HR = 2.14, p < 0.0001), nephropathy (HR = 1.54, p < 0.0001), coronaropathy (HR = 1.26, p = 0.036), and infection/necrosis of the foot (dry, HR = 1.42, p = 0.040; wet, HR = 2.04, p < 0.0001) are associated with 1 year mortality. No sex-linked difference in mortality statistics. Conclusion: Women exhibit fewer comorbidities but are struck by CLTI when over 75, a factor associated with short- and mid-term mortality, explaining why mortality does not statistically differ between the sexes.