With an aging patient population and a growing epidemic of diabetes, the prevalence of peripheral arterial disease (PAD) continues to rise; nearly 8.5 million Americans have received a diagnosis of PAD [1,2]. Chronic limb-threatening ischemia (CLTI), with symptoms including ischemia rest pain or tissue loss, has a nearly 25% risk of limb loss at 1 year [3,4]. As such, with the growing incidence of PAD, there has been a corresponding increase in the rates of nontraumatic major amputations over the past decade [2,5,6]. There is a common misconception that PAD is less prevalent in females. The premenopausal hormonal milieu provides a degree of protection against nitric oxide–dependent endothelial dysfunction, resulting in a lower rate of PAD development in the sixth and seventh decades of life [7], [8], [9]. However, in the subsequent decades, females eclipse men, with a drastic rise in PAD rates in females compared with men older than 80 years [10,11]. The Females's Health and Aging Study estimated that nearly 35% of females older than 65 years have PAD; 8.4% have moderate to severe PAD and only one-half of these females were aware they had PAD [12].

The underdiagnosis of PAD in females patients is multifactorial, including delayed presentation and varied clinical presentation compared with men [13,14]. Females are particularly susceptible to traditional risk factors for PAD and, therefore, they often present older; are non-White; have a remote smoking history; and have higher rates of obesity. Moreover, females tend to present with more advanced Rutherford classification and femoral-popliteal disease [15,36]. Studies have suggested that females have inferior outcomes compared with men after both open surgical and endovascular revascularization, with higher rates of complications, reinterventions, and limb loss [14,15,[16], [17], [18], [19], [20]. Over the past decade, there has been a drastic rise in the utilization of endovascular revascularization for patients with PAD and CLTI [21], [22], [23]. Evaluation of sex-specific outcomes of endovascular interventions for PAD have been limited due to either single-institutional studies or results stemming from randomized controlled trials in which females are underrepresented. As such, we sought to perform a systematic review to evaluate outcomes in females patients undergoing endovascular peripheral interventions for PAD.