Jornal Vascular Brasileiro
Jornal Vascular Brasileiro
Original Article

In-hospital mortality in patients with acute limb ischemia over a 12-year period in the Brazilian public health-care system  

João Henrique Fonseca do Nascimento, André Gusmão Cunha, André Bouzas de Andrade, Monique Magnavita Borba da Fonseca Cerqueira

Downloads: 0
Views: 122


Background: Arterial diseases represent a severe public health problem in the 21st century. Although men have a higher overall prevalence, reports have suggested that women may exhibit atypical manifestations, be asymptomatic, and have hormonal peculiarities, resulting in worse outcomes and severe emergencies, such as acute limb ischemia (ALI).

To analyze the morbidity and mortality profile of ALI emergencies in Brazil between 2008 and 2019. Methods: An ecological study was carried out with secondary data from SIH/SUS, using ICD-10 code I.74 The proportions of emergency hospital admissions and in-hospital mortality rates (HMR) by gender, ethnicity, and age were extracted from the overall figures. P<0.05 was considered significant.

Results: From 2008 to 2019, there were 195,567 urgent hospitalizations due to ALI in Brazil, 111,145 (56.8%) of which were of men. Women had a higher HMR (112:1,000 hospitalizations) than men (85:1,000 hospitalizations) (p<0.05), and a higher chance of death (OR=1.36; p<0.05). Furthermore, mean survival was significantly higher among men (8,483/year versus 6,254/year; p<0.05). Stratified by ethnicity, women who self-identified as white (OR=1.44; p<0.05), black (OR=1.33; p<0.05), and brown (RR=1.25; p <0.05) had greater chances of death than men in the same ethnicity categories.

Moreover, women over the age of 50 years had a higher chance of death, with a progressive increment in risk as age increased. Conclusions: There was a trend to worse prognosis in ALI emergencies associated with women, especially in older groups. The literature shows that the reasons for these differences are still poorly investigated and more robust studies of this relevant disease in the area of vascular surgery are encouraged. 


peripheral arterial diseases; arterial obstructive diseases; emergencies; gender; in-hospital mortality


1. Veenstra EB, van der Laan MJ, Zeebregts CJ, de Heide EJ, Kater M, Bokkers RPH. A systematic review and meta-analysis of endovascular and surgical revascularization techniques in acute limb ischemia. J Vasc Surg. 2020;71(2):654-668.e3. PMid:31353270.
2. Hess CN, Huang Z, Patel MR, et al. Acute limb ischemia in peripheral artery disease. Circulation. 2019;140(7):556-65. PMid:31238713.
3. Collins TC, Petersen NJ, Suarez-Almazor M. Peripheral arterial disease symptom subtype and walking impairment. Vasc Med. 2005;10(3):177-83. PMid:16235770.
4. Hiramoto JS, Katz R, Weisman S, Conte M. Gender-specific risk factors for peripheral artery disease in a voluntary screening population. J Am Heart Assoc. 2014;3(2):e000651. PMid:24627420.
5. McDermott MMG, Greenland P, Liu K, et al. Leg symptoms in peripheral arterial disease associated clinical characteristics and functional impairment. JAMA. 2001;286(13):1599-606. PMid:11585483.
6. Fluck F, Augustin AM, Bley T, Kickuth R. Current Treatment Options in Acute Limb Ischemia Aktuelle Behandlungsmöglichkeiten der akuten Extremitätenischämie. Fortschr Röntgenstr. 2019;192:319-26.
7. Björck M, Earnshaw JJ, Acosta S, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2020 clinical practice guidelines on the management of acute limb ischaemia. Eur J Vasc Endovasc Surg. 2020;59(2):173-218. PMid:31899099.
8. Ferranti KM, Osler TM, Duffy RP, Stanley AC, Bertges DJ. Association between gender and outcomes of lower extremity peripheral vascular interventions. J Vasc Surg. 2015;62(4):990-7. PMid:26209578.
9. dos Santos VP, Alves CAS, Lopes CF, de Araújo Filho JS. Diferenças entre os gêneros em pacientes com isquemia crítica por doença arterial obstrutiva periférica. J Vasc Bras. 2013;12:278-83.
10. Al-Zoubi NA, Shatnawi NJ. Gender variation in symptomatic peripheral arterial occlusive disease among type-2 diabetic patients. SAGE Open Med. 2019;7:2050312119840198. http:// PMid:30967952.
11. Maggio M, Cattabiani C, Lauretani F, et al. The relationship between sex hormones, sex hormone binding globulin and peripheral artery disease in older persons. Atherosclerosis. 2012;225(2):469-74. PMid:23102785.
12. Boese AC, Kim SC, Yin KJ, Lee JP, Hamblin MH. Sex differences in vascular physiology and pathophysiology: Estrogen and androgen signaling in health and disease. Am J Physiol Heart Circ Physiol. 2017;313(3):H524-45.
13. Alves ERP, Costa AM, Bezerra SMMS, Nakano AMS, Cavalcanti AMTS, Dias MD. Climacteric: intensity of symptoms and sexual performance. Texto Contexto Enferm. 2015;1(1):64-71.
14. Aboyans V, Criqui MH, McClelland RL, et al. Intrinsic contribution of gender and ethnicity to normal ankle-brachial index values: The Multi-Ethnic Study of Atherosclerosis (MESA). J Vasc Surg. 2007;45(2):319-27. PMid:17264011.
15. Aboyans V, Lacroix P, Doucet S, Preux PM, Criqui MH, Laskar M. Diagnosis of peripheral arterial disease in general practice: can the ankle-brachial index be measured either by pulse palpation or an automatic blood pressure device? Int J Clin Pract. 2008;62(7):1001-7. PMid:18462371. 
16. Patel T, Baydoun H, Patel NK, et al. Peripheral arterial disease in women: the gender effect. Cardiovasc Revasc Med. 2020;21(3):404-8. PMid:31327711.
17. Collins TC, Suarez-Almazor M, Bush RL, Petersen NJ. Gender and peripheral arterial disease. J Am Board Fam Med. 2006;19(2):132-40. PMid:16513901.
18. Egorova N, Vouyouka AG, Quin J, et al. Analysis of gender-related differences in lower extremity peripheral arterial disease. J Vasc Surg. 2010;51(2):372-8. PMid:20022204.
19. Lejay A, Schaeffer M, Georg Y, et al. Gender related Long-term Differences after Open Infrainguinal Surgery for Critical Limb Ischemia. Eur J Vasc Endovasc Surg. 2015;50(4):506-12. PMid:26296427.
20. Nascimento BR, Brant LC, Lana ML, Lopes EL, Ribeiro AL. Trends in Procedure Type, Morbidity and In-Hospital Outcomes of Patients with Peripheral Artery Disease: Data from the Brazilian Public Health System. Ann Vasc Surg. 2016;31:143-51. PMid:26616503.
21. Mathews L, Subramanya V, Zhao D,  et  al. Endogenous Sex Hormones and Endothelial Function in Postmenopausal Women and Men: The Multi-Ethnic Study of Atherosclerosis. J Womens Health (Larchmt). 2019;28(7):900-9. PMid:31170017
22. Haring R, Travison TG, Bhasin S,  et  al. Relation between sex hormone concentrations, peripheral arterial disease, and change in ankle-brachial index: Findings from the Framingham Heart Study. J Clin Endocrinol Metab. 2011;96(12):3724-32. PMid:21937625.
23. Howard DP, Banerjee A, Fairhead JF, Hands L, Silver LE, Rothwell PM. Population-based study of incidence, risk factors, outcome, and prognosis of ischemic peripheral arterial events: implications for prevention. Circulation. 2015;132(19):1805-15. PMid:26350058.
24. Caro J, Migliaccio-Walle K, Ishak KJ, Proskorovsky I. The morbidity and mortality following a diagnosis of peripheral arterial disease: long-term follow-up of a large database. BMC Cardiovasc Disord. 2005;5(1):14. PMid:15972099.
25. Collins TC, Petersen NJ, Suarez-Almazor M, Ashton CM. The prevalence of peripheral arterial disease in a racially diverse population. Arch Intern Med. 2003;163(12):1469-74. PMid:12824097.
26. Rowe VL, Weaver FA, Lane JS, Etzioni DA. Racial and ethnic differences in patterns of treatment for acute peripheral arterial disease in the United States, 1998-2006. J Vasc Surg. 2010;51(4, Suppl.):21S-6S. PMid:20080006.
27. Alvim RO, Dias FAL, Oliveira CM, et al. Prevalence of Peripheral Artery Disease and Associated Risk Factors in a Brazilian Rural Population: The Baependi Heart Study. Int. J. Cardiovasc. Sci. 2018;31:405-13.
28. Forbang NI, Criqui MH, Allison MA, et al. Sex and ethnic differences in the associations between lipoprotein(a) and peripheral arterial disease in the Multi-Ethnic Study of Atherosclerosis. J Vasc Surg. 2016;63(2):453-8. PMid:26518096.

Submitted date:

Accepted date:

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
620a693ba95395359a21ee85 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections