Abstract
Abstract. This article analyses if and to what extent gender differences exist in abdominal aortic aneurysm (AAA) therapy. For this purpose Medline (PubMed) was searched from January 1999 to January 2018. Keywords were: “abdominal aortic aneurysm”, “gender”, “prevalence”, “EVAR”, and “open surgery of abdominal aortic aneurysm”. Regardless of open or endovascular treatment of abdominal aortic aneurysms, women have a higher rate of complications and longer hospitalizations compared to men. The majority of studies showed that women have a lower survival rate for surgical and endovascular treatment of abdominal aneurysms after both elective and emergency interventions. Women receive less surgical/interventional and protective medical treatment. Women seem to have a higher risk of rupture, a lower survival rate in AAA, and a higher rate of complications, regardless of endovascular or open treatment. The gender differences may be due to a higher age of women at diagnosis and therapy associated with higher comorbidity, but also because of genetic, hormonal, anatomical, biological, and socio-cultural differences. Strategies for treatment in female patients must be further defined to optimize outcome.
Literature
ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European society of cardiology (ESC). Eur Heart J. 2014;35(41):2873–926.
.Editor´s choice-Management of Descending Thoracic Aorta Diseases Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS) Writing Committee. Eur J Vasc Endovasc Surg. 2017;53:4–52.
Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg. 2011;41:1–58.
The PRISMA group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. Int J Surg. 2010;8(5):336–41.
.A further meta-analysis of population-based screening for abdominal aortic aneurysm. J Vasc Surg. 2010;52:1103–8.
.Low prevalence of abdominal aortic aneurysm among 65-year-old Swedish men indicates a change in the epidemiology of the disease. Circulation. 2011;124(10):1118–23.
.Meta-analysis of the current prevalence of screen-detected abdominal aortic aneurysm in women. Br J Surg. 2016;103(9):1097–104.
.Randomized clinical trial of screening for abdominal aortic aneurysm in women. Br J Surg. 2002;89:283–5.
.Abdominal aortic aneurysms in women. J Vasc Surg. 2013;57(4):3–10.
.Sexual dimorphism of abdominal aortic aneurysms: a striking example of “male disadvantage” in cardiovascular disease. Atherosclerosis. 2012;225(1):22–8.
.Women with abdominal aortic aneurysms have more extensive aortic neck pathology. Ann Vasc Surg. 2013;27(5):547–52.
.Interheart study investigators. Tobacco use and risk of myocardial infarction in 52 countries in the Interheart study: a case-control study. Lancet. 2006;368(9536):647–58.
Smoking, sex, risk factors and abdominal aortic aneurysms: a prospective study of 18782 persons aged above 65 years in the Southern Community Cohort Study. J Epidemiol Comm Health. 2015;69:481–8.
Current prevalence of abdominal aortic aneurysm in 70-year-old women. Br J Surg. 2013;100:367–72.
.Gender-related impact on outcomes of high density lipoprotein in acute ST-elevation myocardial infarction. Atherosclerosis. 2016;251:460–6.
Sex and gender differences in control of blood pressure. Clin Sci (Lond). 2013;125(7):311–8.
.Endovascular abdominal aortic aneurysm repair in women. Acta Chir Belg. 2011;111(1):2–6.
.GenTAC Registry Consortium. GenTAC registry report: gender differences among individuals with genetically triggered thoracic aortic aneurysm and dissection. Am J Med Genet A. 2013;161(4):779–86.
Thoracic aortic aneurysm frequency and dissection are associated with fibrillin-1 fragment concentrations in circulation. Circ Res. 2013;113:1159–68.
Reconsidering gender relative to risk of rupture in the contemporary management of abdominal aortic aneurysms. J Vasc Surg. 2015;62:1429–36.
Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants. Ann Surg. 1999;230(3):289–97.
.Surveillance intervals or small abdominal aortic aneurysms: a meta-analysis. JAMA. 2013;309:806–13.
.Relative importance of aneurysm diameter and body size for predicting AAA rupture in men and women. J Vasc Surg. 2014;59(5):1209–6.
on behalf of the Vascular Study Group of New England.The risk of rupture in untreated aneurysms: the impact of size, gender, and expansion rate. J Vasc Surg. 2003;37(2):280–4.
.Systematic review and meta-analysis of sex differences in outcome after intervention for abdominal aortic aneurysm. Br J Surg. 2010;97:1169–79.
.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):891–9.
.Gender trends in the repair of ruptured abdominal aortic aneurysms and outcomes. J Vasc Surg. 2010;51:9–13.
.Association between sex and perioperative mortality following endovascular repair for ruptured abdominal aortic aneurysms. J Vasc Surg. 2013;57:1684–92.
Gender and 30-day outcome in patients undergoing endovascular aneurysm repair (EVAR): an analysis using the ACS NSQIP dataset. J Vasc Surg. 2009;50:486–91.
.More patients are treated for nonruptured abdominal aortic aneurysms, but the proportion of women remains unchanged. J Vasc Surg. 2008;48(4):802–7.
.Evolution of gender-related differences in outcomes from two decades of endovascular aneurysm repair. J Vasc Surg. 2015;61:843–52.
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):1–12.
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;43:230–8.
.Different disease profiles for women and men with abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2007;33(5):556–60.
.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):42–9.
.Mortality in endovascular and open abdominal aneurysm repair – trends in Germany. Vasa. 2018;47(1):43–8.
.Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis. Lancet. 2017;389(10088):2482–91.
.Regional differences in case mix and peri-operative outcome after elective abdominal aortic aneurysm repair in the vascunet database. Eur J Vasc Endovasc Surg. 2015;49:646–52.
Glasgow aneurysm score in predicting outcome after ruptured abdominal aortic aneurysm. Vascular. 2015;23(2):120–3.
Thirty-day outcomes after elective percutaneous or open endovascular repair of abdominal aortic aneurysms. Ann Vasc Surg. 2016;31:46–51.
.Women undergoing aortic surgery are at higher risk for unplanned readmissions compared with men especially when discharged home. J Vasc Surg. 2016;63:1496–504.
Abdominal aortic aneurysms in women. J Vasc Surg. 2016;63(3):839–44.
.