Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec;12(12):794-802.
doi: 10.14740/jocmr4376. Epub 2020 Dec 18.

Gender-Based Differences in Abdominal Aortic Aneurysm Rupture: A Retrospective Study

Srikrishna Varun Malayala  1 , Ambreen Raza  2 , Rachana Vanaparthy  3
Affiliations

Gender-Based Differences in Abdominal Aortic Aneurysm Rupture: A Retrospective Study

Srikrishna Varun Malayala et al. J Clin Med Res. 2020 Dec.

Abstract

Background: Annually, 5% of sudden deaths are due to abdominal aortic aneurysm (AAA) rupture. There is evidence suggesting that AAA ruptures have worse outcomes in females than males and the aneurysms rupture at a smaller size in females than in males. The United States Preventive Services Task Force (USPSTF) recommends a one-time ultrasound screening for males aged 65 - 75 years who ever smoked. There is insufficient evidence to screen females aged 65 - 75 years who ever smoked though there is evidence suggesting that AAAs rupture at a smaller size and have worse outcomes in females. The objective of this study is to compare the characteristics, mortality and morbidity of ruptured AAAs in females and males.

Methods: This is a retrospective review of 117 patients from two teaching institutions over a period of 6 years. A total of 39 parameters were compared between males and females including demographic variables, comorbidities like hypertension, dyslipidemia, cardiovascular diseases; previous history of AAA; medications, characteristics of aneurysm, type of surgery and its outcome; postoperative complications and long-term survival.

Results: The overall incidence of AAA rupture was higher in males (68%) than in females (32%). Females die from AAA rupture at a later age. There was a significant difference in the size of AAA rupture between females (mean = 7.4 cm, standard deviation (SD) = 2.0) and males (mean = 8.2 cm, SD = 1.8; P = 0.04). The probability to undergo surgery for ruptured AAA was significantly lower for females as compared to males (P = 0.03). Females had higher overall mortality (P = 0.001), postoperative mortality (P = 0.02), higher length of intensive care unit (ICU) stay, incidence of postoperative complications, use of vasopressors and use of ventilator.

Conclusions: Using a similar threshold of size of AAA for elective surgery for both males and females might not be appropriate. Further population-based studies are needed to warrant AAA screening for high-risk females owing to the higher morbidity and mortality.

Keywords: AAA; Aneurysm; Females; Mortality; Rupture; Screening; Ultrasound.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest reported by any of the authors.

Figures

Figure 1
Figure 1
Inclusion and exclusion criteria of the study.
Figure 2
Figure 2
Age specific distribution of male and female patients admitted with abdominal aortic aneurysm (AAA). It was noted that 65.8% of the male patients admitted with AAA rupture were under 85 years of age and 65.7% of the female patients admitted for AAA rupture were more than 85 years old.
Figure 3
Figure 3
Long-term (over 2 years) survival of the patients discharged alive after AAA repair. X axis represents the months of survival after an emergent abdominal aortic aneurysm (AAA) repair. Y axis is the survival of the patients on a scale of 1 to 0. Males survived an average of 11.0 months (SD = 2.2 months) as compared to 9.3 months in the females (SD = 2.9 months, P = 0.41). The total sample available for the analysis was 27 patients, 21 males and six females.
See this image and copyright information in PMC

References

    1. O'Donnell TFX, Verhagen HJ, Pratesi G, Pratesi C, Teijink JAW, Vermassen FEG, Mwipatayi P. et al. Female sex is associated with comparable 5-year outcomes after contemporary endovascular aneurysm repair despite more challenging anatomy. J Vasc Surg. 2020;71(4):1179–1189. doi: 10.1016/j.jvs.2019.05.065. - DOI - PMC - PubMed
    1. Grootenboer N, Bosch JL, Hendriks JM, van Sambeek MR. Epidemiology, aetiology, risk of rupture and treatment of abdominal aortic aneurysms: does sex matter? Eur J Vasc Endovasc Surg. 2009;38(3):278–284. doi: 10.1016/j.ejvs.2009.05.004. - DOI - PubMed
    1. Ash JL, Khan KD, Syed MH. Abdominal aortic aneurysms in women: the debate continues. Endovascular Today. 2018;1
    1. Brown PM, Zelt DT, Sobolev B. The risk of rupture in untreated aneurysms: the impact of size, gender, and expansion rate. J Vasc Surg. 2003;37(2):280–284. doi: 10.1067/mva.2003.119. - DOI - PubMed
    1. Stuntz M, Audibert C, Su Z. Persisting disparities between sexes in outcomes of ruptured abdominal aortic aneurysm hospitalizations. Sci Rep. 2017;7(1):17994. doi: 10.1038/s41598-017-18451-2. - DOI - PMC - PubMed

LinkOut - more resources