# Walking on Collaterals: Unveiling Discrepancies in Gender-Based Variances in Peripheral Arterial Disease

## TL;DR

This case study explores why a woman's severe peripheral arterial disease went undiagnosed for years, highlighting gender-based differences in symptoms and healthcare outcomes.

## Contribution

The paper emphasizes the need for early screening and awareness of atypical PAD symptoms in women to reduce healthcare disparities.

## Key findings

- Women with PAD often have atypical or absent symptoms, leading to underdiagnosis.
- Early screening with the Ankle-Brachial Index is crucial for accurate PAD diagnosis in women.
- Inadequate recognition of PAD in women results in poorer treatment and outcomes.

## Abstract

A case of a 63-year-old woman with hypertension, chronic kidney disease, and osteoporosis who presented with acute coronary syndrome and new-onset heart failure. Angiography revealed a completely obstructed abdominal aorta, with no circulation to the femoral arteries and perfusion only through collateral vessels. This severe peripheral arterial disease (PAD) was diagnosed during her hospitalization, raising the question of why it had remained undiagnosed for years and whether earlier detection could have improved her outcome. Women with PAD often present with atypical or absent symptoms, leading to underdiagnosis. Early screening with the Ankle-Brachial Index (ABI) is crucial for accurate diagnosis. Moreover, gaps in PAD recognition led to inadequate treatment of comorbidities, less aggressive pharmacologic therapies, and fewer revascularization strategies, resulting in poorer outcomes. This case highlights the unique risk factors and diagnostic challenges in women with PAD, which contribute to healthcare disparities.