Abdominal aortic aneurysm (AAA) primarily affects male patients; however, female patients with AAA have a faster rate of aneurysm growth, have higher risk of rupture even at smaller diameters, and have worse outcomes following repair of ruptured and intact aneurysms. Furthermore, early natural history studies and randomized controlled trials evaluating surveillance versus repair in small aneurysms were conducted primarily in male patients. Therefore, there are limited data regarding the ideal threshold for elective repair of AAA in women, either by aortic diameter or by alternative measures. We review the existing literature regarding AAA in women and consider the most appropriate threshold for repair.
UlugPPowellJTSweetingMJBownMJThompsonSGGroupSC. Meta-analysis of the current prevalence of screen-detected abdominal aortic aneurysm in women. Br J Surg. 2016;103(9):1097–1104.
2.
BeckAWSedrakyanAMaoJ. Variations in abdominal aortic aneurysm care: a report from the international consortium of vascular registries. Circulation. 2016;134(24):1948–1958.
3.
MofidiRGoldieVJKelmanJDawsonARMurieJAChalmersRT. Influence of sex on expansion rate of abdominal aortic aneurysms. Br J Surg. 2007;94(3):310–314.
4.
BrownLCPowellJT. Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants. Ann Surg. 1999;230(3):289–296; discussion 96-7.
5.
LoRCBensleyRPHamdanAD. Gender differences in abdominal aortic aneurysm presentation, repair, and mortality in the Vascular Study Group of New England. J Vasc Surg. 2013;57(5):1261–1268, 8e1–e5.
6.
LoRCLuBFokkemaMT. Relative importance of aneurysm diameter and body size for predicting abdominal aortic aneurysm rupture in men and women. J Vasc Surg. 2014;59(5):1209–1216.
7.
PowellJTBradyARBrownLC.; United Kingdom Small Aneurysm Trial Participants. Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med. 2002;346(19):1445–1452.
8.
DeerySESodenPAZettervallSL. Sex differences in mortality and morbidity following repair of intact abdominal aortic aneurysms. J Vasc Surg. 2017;65(4):1006–1013.
9.
LederleFAJohnsonGRWilsonSE. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA. 2002;287(22):2968–2972.
10.
LederleFAWilsonSEJohnsonGR. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med. 2002;346(19):1437–1444.
11.
PowellJTBrownLCForbesJF. Final 12-year follow-up of surgery versus surveillance in the UK Small Aneurysm Trial. Br J Surg. 2007;94(6):702–708.
12.
ChaikofELBrewsterDCDalmanRL. SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: executive summary. J Vasc Surg. 2009;50(4):880–896.
13.
Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. The UK Small Aneurysm Trial Participants. Lancet. 1998;352(9141):1649–1655.
14.
CaoPDe RangoPVerziniF. Comparison of Surveillance Versus Aortic Endografting for Small Aneurysm Repair (CAESAR): results from a randomised trial. Eur J Vasc Endovasc Surg. 2011;41(1):13–25.
15.
OurielKClairDGKentKCZarinsCK;Positive Impact of Endovascular Options for Treating Aneurysms Early Investigators. Endovascular repair compared with surveillance for patients with small abdominal aortic aneurysms. J Vasc Surg. 2010;51(5):1081–1087.
16.
SkibbaAAEvansJRHopkinsSP. Reconsidering gender relative to risk of rupture in the contemporary management of abdominal aortic aneurysms. J Vasc Surg. 2015;62(6):1429–1436.
17.
FillingerMFMarraSPRaghavanMLKennedyFE. Prediction of rupture risk in abdominal aortic aneurysm during observation: wall stress versus diameter. J Vasc Surg. 2003;37(4):724–732.
18.
LarssonEGranathFSwedenborgJHultgrenR. More patients are treated for nonruptured abdominal aortic aneurysms, but the proportion of women remains unchanged. J Vasc Surg. 2008;48(4):802–807.
19.
Vande GeestJPDillavouEDDi MartinoES. Gender-related differences in the tensile strength of abdominal aortic aneurysm. Ann N Y Acad Sci. 2006;1085:400–402.
20.
VillardCErikssonPHanemaaijerRLindemanJHHultgrenR. The composition of collagen in the aneurysm wall of men and women. J Vasc Surg. 2017;66(2):579–585.
21.
VillardCErikssonPKronqvistM. Differential expression of sex hormone receptors in abdominal aortic aneurysms. Maturitas. 2017;96:39–44.
22.
DaviesRRGalloACoadyMA. Novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms. Ann Thorac Surg. 2006;81(1):169–177.
23.
McPheeJTHillJSEslamiMH. The impact of gender on presentation, therapy, and mortality of abdominal aortic aneurysm in the United States, 2001–2004. J Vasc Surg. 2007;45(5):891–899.
24.
De RangoPSimonteGManzoneA. Mortality risk for ruptured abdominal aortic aneurysm in women. Ann Vasc Surg. 2017;39:143–151.
25.
GrootenboerNBoschJLHendriksJMvan SambeekMR. Epidemiology, aetiology, risk of rupture and treatment of abdominal aortic aneurysms: does sex matter?Eur J Vasc Endovasc Surg. 2009;38(3):278–284.
26.
DillavouEDMulukSCMakarounMS. A decade of change in abdominal aortic aneurysm repair in the United States: have we improved outcomes equally between men and women?J Vasc Surg. 2006;43(2):230–238; discussion 8.
27.
HultgrenRVishnevskayaLWahlgrenCM. Women with abdominal aortic aneurysms have more extensive aortic neck pathology. Ann Vasc Surg. 2013;27(5):547–552.
28.
EgorovaNNVouyoukaAGMcKinseyJF. Effect of gender on long-term survival after abdominal aortic aneurysm repair based on results from the Medicare national database. J Vasc Surg. 2011;54(1):1–12e6; discussion 1-2.
29.
AbediNNDavenportDLXenosESorialEMinionDJEndeanED. Gender and 30-day outcome in patients undergoing endovascular aneurysm repair (EVAR): an analysis using the ACS NSQIP dataset. J Vasc Surg. 2009;50(3):486–491, 91e1–4.
30.
ChungCTadrosRTorresM. Evolution of gender-related differences in outcomes from two decades of endovascular aneurysm repair. J Vasc Surg. 2015;61(4):843–852.
31.
DesaiMChokeESayersRDNathMBownMJ. Sex-related trends in mortality after elective abdominal aortic aneurysm surgery between 2002 and 2013 at National Health Service hospitals in England: less benefit for women compared with men. Eur Heart J. 2016;37(46):3452–3460.
32.
GrootenboerNHuninkMGHendriksJMvan SambeekMRButhJcollaboratorsE. Sex differences in 30-day and 5-year outcomes after endovascular repair of abdominal aortic aneurysms in the EUROSTAR study. J Vasc Surg. 2013;58(1):42–49e1.
33.
MehtaMByrneWJRobinsonH. Women derive less benefit from elective endovascular aneurysm repair than men. J Vasc Surg. 2012;55(4):906–913.
34.
SweetMPFillingerMFMorrisonTMAbelD. The influence of gender and aortic aneurysm size on eligibility for endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2011;54(4):931–937.
NzaraRRybinDDorosG. Perioperative outcomes in patients requiring iliac conduits/access for endovascular abdominal aortic aneurysm repair. Ann Vasc Surg. 2015;61(4):843–852.
39.
StorckMNolteTTenholtMMaeneLMaleuxGScheinertD. Women and men derive comparable benefits with an ultra low-profile endograft: 1-year results of the European OVATION Registry. J Cardiovasc Surg (Torino). 2017;58(5):658–664.
40.
SodenPAZettervallSLUlteeKH. Outcomes for symptomatic abdominal aortic aneurysms in the American College of Surgeons National Surgical Quality Improvement Program. J Vasc Surg. 2016;64(2):297–305.
41.
FlinkBJLongCADuwayriY. Women undergoing aortic surgery are at higher risk for unplanned readmissions compared with men especially when discharged home. J Vasc Surg. 2016;63(6):1496–1504e1.
42.
National Center for Health Statistics. Health, United States, 2015: With Special Features on Racial and Ethnic Health Disparities. Hyattsville, MD: US Department of Health and Human Services, 2016. Report No.
