Reconsidering gender relative to risk of rupture in the contemporary management of abdominal aortic aneurysms

Objective Abdominal aortic aneurysms (AAAs) may rupture at smaller diameters in women than in men, and women may be at higher risk and have poorer outcomes in elective and emergent interventions because of age and comorbidities. Practice guidelines recommending elective AAA repair at >5.5 cm are...

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Bibliographic Details
Published in:Journal of vascular surgery 2015-12, Vol.62 (6), p.1429-1436
Main Authors: Skibba, Afshin A., MD, Evans, James R., MD, Hopkins, Steven P., MD, Yoon, H. Richard, MD, Katras, Tony, MD, Kalbfleisch, John H., PhD, Rush, Daniel S., MD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Aorta, Abdominal - pathology
Aortic Aneurysm, Abdominal - epidemiology
Aortic Aneurysm, Abdominal - pathology
Aortic Aneurysm, Abdominal - surgery
Aortic Rupture - epidemiology
Aortic Rupture - pathology
Comorbidity
Elective Surgical Procedures
Female
Humans
Male
Middle Aged
Practice Guidelines as Topic
Retrospective Studies
Risk Assessment
Sex Factors
Surgery
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Summary:Objective Abdominal aortic aneurysms (AAAs) may rupture at smaller diameters in women than in men, and women may be at higher risk and have poorer outcomes in elective and emergent interventions because of age and comorbidities. Practice guidelines recommending elective AAA repair at >5.5 cm are gender neutral and may not adequately reflect increased risks in women or the potential advantages of elective lower risk endovascular procedures. Methods Patients with a diagnosis of AAA discharged from a single referral hospital during a 14-year period were identified for retrospective analysis. Results A total of 2121 patients with AAAs were studied, 499 women (23.5%) and 1622 men (76.5%). Women were older and had a greater incidence of hypertension, smoking, chronic obstructive pulmonary disease, dyslipidemia, and renal insufficiency. Intact AAAs in 467 women had a mean diameter of 4.4 ± 1.3 cm compared with 1538 men at 5.0 ± 1.4 cm ( P  < .01). The ruptured AAAs in 32 women (6.4%) had a mean diameter of 6.1 ± 1.5 cm compared with 84 men (5.2%) at 7.7 ± 1.9 cm ( P  < .01). Women had a twofold increased frequency of AAA rupture than men at all size intervals ( P  < .01). The frequency of ruptured AAAs 
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2015.07.079