Gender Considerations in Peripheral Vascular Disease

Peripheral vascular disease (PVD) encompasses disease processes in the vascular bed outside of the coronary circulation. The focus of this chapter is on the diagnosis and management of these diseases with an emphasis on the gender based differences. We mainly discuss arterial disease where the most common pathology involves atherosclerotic disease. The chapter outline the disease process in three major territories: Carotid Artery Atherosclerotic Disease, Abdominal Aortic Aneurysms, and Lower Extremity Atherosclerotic Ischemic Disease. In addition to being commonly encountered, these diseases are discussed because they are considered coronary artery disease equivalents and included as such in the Framingham risk calculation. Even though the clinical consequences of atherosclerosis vary according to the territory involved, mortality is highly related to coexisting coronary involvement. Cardiac death represents 70 % of the overall mortality of patients with peripheral vascular disease [1]. The involvement of multiple vascular beds appears to be an expression of more advanced atherosclerotic disease process associated with a worse prognosis. The understanding of this process is critical for the development of preventive strategies and institution of appropriate treatment. A significant amount of patients carrying these conditions remain undiagnosed for many years. This is true for both genders. However, women are more likely to suffer from undiagnosed peripheral vascular disease. Increased awareness and dedicated research in this area can help overcome gender-based misconceptions to both prevent peripheral vascular disease in women and help clinicians and patients more effectively address these diseases when manifested. In addition, a major goal in combating these diseases should be the primary prevention of atherosclerotic disease (discussed elsewhere).