Current issues in the treatment of women with abdominal aortic aneurysm

Abstract

Background: Abdominal aortic aneurysm (AAA) accounts for approximately 45,000 deaths per year in the United States. Despite a striking male predominance of AAA (4:1 male to female), mortality from this disease is almost as high in women (20th leading killer of women and 15th leading killer of men in this country).

Objective: The purpose of this review is to highlight the differences in diagnosis, treatment, and treatment outcomes for women with AAA to determine avenues of potential improvement in their care.

Methods: Published articles relevant to this review were determined by the experience of the author, by PubMed and MEDLINE searches, and by reviewing the references cited in the reports identified by the first 2 methods. The database searches were performed using the following terms: abdominal aorta, aneurysm, gender, endovascular, and outcomes. Reports were limited to the English language and publication since 1995.

Results: Compared with men, women are older when their AAA is diagnosed and treated. Women have higher mortality than do men while undergoing elective open and endovascular repairs, and emergency surgery for ruptured AAAs. Owing to the anatomic complexity of their arterial anatomy, women are less frequently candidates for endovascular repair. Women receive treatment for rupture of AAA less frequently than do men. On Medicare induction, both men and women are eligible for a one-time screening for AAA; however, women qualify for this exam only if they have a family history of AAA.

Conclusions: Opportunities to advance the care of women with AAA include improving screening techniques to find AAA prior to rupture and when women are younger and more likely to be candidates for repair. Current clinical practice should focus on decreasing mortality for open surgical repair and developing better endovascular devices so that anatomic obstacles can be overcome and more women can be candidates for this technology. In addition, furthering the understanding of gender differences in the pathophysiology of AAA disease may provide insights into treatments that could prevent the formation of aneurysms.