Evaluation of sex-based differences in below-the-knee plaque histology in patients who underwent amputation for chronic limb-threatening ischemia
Objective: With the growing incidence of peripheral arterial disease (PAD) and the historic under-representation of female patients in cardiovascular trials, a comprehensive evaluation of sex-based variances in PAD presentation and treatment outcomes is needed. This study aims to evaluate sex-based...
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Elsevier
2025-01-01
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| Series: | JVS - Vascular Science |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666350324000804 |
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| author | Fouzul Kansul Deborah Vela, MD Judit Csore, MD Bright Benfor, MD Sasha Suarez, MD Anahita Dua, MD, MBA, MSC Trisha L. Roy, MD, PhD |
| author_facet | Fouzul Kansul Deborah Vela, MD Judit Csore, MD Bright Benfor, MD Sasha Suarez, MD Anahita Dua, MD, MBA, MSC Trisha L. Roy, MD, PhD |
| author_sort | Fouzul Kansul |
| collection | DOAJ |
| description | Objective: With the growing incidence of peripheral arterial disease (PAD) and the historic under-representation of female patients in cardiovascular trials, a comprehensive evaluation of sex-based variances in PAD presentation and treatment outcomes is needed. This study aims to evaluate sex-based differences in the vessel wall characteristics of patients who underwent amputation owing to critical limb-threatening ischemia to optimize personalized treatment planning and aid in the selection of endovascular devices for PAD patients. Methods: A total of 35 lower limbs were collected from 34 patients with end-stage PAD undergoing major amputation. We selected, harvested, and cross-sectioned at 3- to 4-mm intervals 163 diseased below-the-knee arterial segments resulting in 1260 arterial rings. Histological analyses were conducted on each individual ring and later summarized by arterial segment. Results: Male and female patients were remarkably similar across multiple plaque characteristics, including degree of stenosis, calcification severity and localization, and atherosclerotic patterns. A significant sex-based difference was noted in the presence of luminal thrombus, which was more prevalent in females (38.7% vs 25.0%; P = .016). Histopathological differences were noted between popliteal and tibial lesions, with popliteal segments demonstrating increased chronic total occlusion presence and atherosclerosis, whereas severe calcification occurred more often in tibial segments. A sex-based evaluation of the popliteal segments showed increased calcification (60.71% vs 28.0%; P = .003) and atherosclerosis (96.4% vs 73.0%; P = .028) in males compared with females. Conclusions: Differences in the degree of calcification, incidence of atherosclerosis, and presence of luminal thrombus may pose important clinical implications for antiplatelet and anticoagulation regimen choice and guide treatment options. Further studies are warranted to evaluate the impact of these differences on outcomes of endovascular procedures. |
| format | Article |
| id | doaj-art-6801698781bd4420ad2f9c9db9bfb95f |
| institution | Kabale University |
| issn | 2666-3503 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JVS - Vascular Science |
| spelling | doaj-art-6801698781bd4420ad2f9c9db9bfb95f2025-01-20T04:17:52ZengElsevierJVS - Vascular Science2666-35032025-01-016100269Evaluation of sex-based differences in below-the-knee plaque histology in patients who underwent amputation for chronic limb-threatening ischemiaFouzul Kansul0Deborah Vela, MD1Judit Csore, MD2Bright Benfor, MD3Sasha Suarez, MD4Anahita Dua, MD, MBA, MSC5Trisha L. Roy, MD, PhD6Department of Biomedical Engineering, Texas A&M University, College Station, TXDepartment of Cardiovascular Pathology, The Texas Heart Institute, Houston, TXDeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX; Heart and Vascular Center, Semmelweis University, Budapest, HungaryDeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TXDivision of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MADivision of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MADeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX; Correspondence: Trisha L. Roy, MD, PhD, DeBakey Heart and Vascular Center, Houston Methodist Hospital, 6565 Fannin St, Ste 1401, Houston, TX 77030Objective: With the growing incidence of peripheral arterial disease (PAD) and the historic under-representation of female patients in cardiovascular trials, a comprehensive evaluation of sex-based variances in PAD presentation and treatment outcomes is needed. This study aims to evaluate sex-based differences in the vessel wall characteristics of patients who underwent amputation owing to critical limb-threatening ischemia to optimize personalized treatment planning and aid in the selection of endovascular devices for PAD patients. Methods: A total of 35 lower limbs were collected from 34 patients with end-stage PAD undergoing major amputation. We selected, harvested, and cross-sectioned at 3- to 4-mm intervals 163 diseased below-the-knee arterial segments resulting in 1260 arterial rings. Histological analyses were conducted on each individual ring and later summarized by arterial segment. Results: Male and female patients were remarkably similar across multiple plaque characteristics, including degree of stenosis, calcification severity and localization, and atherosclerotic patterns. A significant sex-based difference was noted in the presence of luminal thrombus, which was more prevalent in females (38.7% vs 25.0%; P = .016). Histopathological differences were noted between popliteal and tibial lesions, with popliteal segments demonstrating increased chronic total occlusion presence and atherosclerosis, whereas severe calcification occurred more often in tibial segments. A sex-based evaluation of the popliteal segments showed increased calcification (60.71% vs 28.0%; P = .003) and atherosclerosis (96.4% vs 73.0%; P = .028) in males compared with females. Conclusions: Differences in the degree of calcification, incidence of atherosclerosis, and presence of luminal thrombus may pose important clinical implications for antiplatelet and anticoagulation regimen choice and guide treatment options. Further studies are warranted to evaluate the impact of these differences on outcomes of endovascular procedures.http://www.sciencedirect.com/science/article/pii/S2666350324000804AtherosclerosisCalcificationPeripheral arterial diseaseCritical limb ischemiaMedial calcification |
| spellingShingle | Fouzul Kansul Deborah Vela, MD Judit Csore, MD Bright Benfor, MD Sasha Suarez, MD Anahita Dua, MD, MBA, MSC Trisha L. Roy, MD, PhD Evaluation of sex-based differences in below-the-knee plaque histology in patients who underwent amputation for chronic limb-threatening ischemia JVS - Vascular Science Atherosclerosis Calcification Peripheral arterial disease Critical limb ischemia Medial calcification |
| title | Evaluation of sex-based differences in below-the-knee plaque histology in patients who underwent amputation for chronic limb-threatening ischemia |
| title_full | Evaluation of sex-based differences in below-the-knee plaque histology in patients who underwent amputation for chronic limb-threatening ischemia |
| title_fullStr | Evaluation of sex-based differences in below-the-knee plaque histology in patients who underwent amputation for chronic limb-threatening ischemia |
| title_full_unstemmed | Evaluation of sex-based differences in below-the-knee plaque histology in patients who underwent amputation for chronic limb-threatening ischemia |
| title_short | Evaluation of sex-based differences in below-the-knee plaque histology in patients who underwent amputation for chronic limb-threatening ischemia |
| title_sort | evaluation of sex based differences in below the knee plaque histology in patients who underwent amputation for chronic limb threatening ischemia |
| topic | Atherosclerosis Calcification Peripheral arterial disease Critical limb ischemia Medial calcification |
| url | http://www.sciencedirect.com/science/article/pii/S2666350324000804 |
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