Abdominal aortic aneurysms in women

Lo, Ruby C.; Schermerhorn, Marc L.

doi:10.1016/j.jvs.2015.10.087

Cited by 133 publications

(89 citation statements)

References 67 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Prognosis of abdominal aortic aneurysm is often regarded as worse in women than men, 3,4 with adverse factors likely to include the older age of women, and higher morbidity and mortality after elective aneurysm repair. The data from our systematic review do not suggest that the proportion of women morphologically suitable for EVAR has improved since earlier this century.…”

Section: Discussionmentioning

confidence: 99%

“…Since the rate of rupture of small abdominal aortic aneurysm is four times higher in women than men at the same diameter, 2 women are often considered for repair at diameters smaller than 5·5 cm. Several studies 3,4 have suggested that the prognosis of individuals with abdominal aortic aneurysm is worse for women than men, with the operative mortality following repair of intact aneurysm being higher in women than men.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Ulug¹,

Sweeting²,

vonAllmen³

et al. 2017

Journal of Vascular Surgery

View full text Add to dashboard Cite

1 ArticlesMorphological 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 Pinar Ulug, Michael J Sweeting, Regula S von Allmen, Simon G Thompson, Janet T Powell, on behalf of the SWAN collaborators* Summary Background Prognosis for women with abdominal aortic aneurysm might be worse than the prognosis for men. We aimed to systematically quantify the differences in outcomes between men and women being assessed for repair of intact abdominal aortic aneurysm using data from study periods after the year 2000.Methods In these systematic reviews and meta-analysis, we identified studies (randomised, cohort, or cross-sectional) by searching MEDLINE, Embase, CENTRAL, and grey literature published between Jan 1, 2005, and Sept 2, 2016, for two systematic reviews and Jan 1, 2009, and Sept 2, 2016, for one systematic review. Studies were included if they were of both men and women, with data presented for each sex separately, with abdominal aortic aneurysms being assessed for aneurysm repair by either endovascular repair (EVAR) or open repair. We conducted three reviews based on whether studies reported the proportion morphologically suitable (within manufacturers' instructions for use) for EVAR (EVAR suitability review), non-intervention rates (non-intervention review), and 30-day mortality (operative mortality review) after intact aneurysm repair. Studies had to include at least 20 women (for the EVAR suitability review), 20 women (for the non-intervention review), and 50 women (for the operative mortality review). Studies were excluded if they were review articles, editorials, letters, or case reports. For the operative review, studies were also excluded if they only provided hazard ratios or only reported in-hospital mortality. We assessed the quality of the studies using the NewcastleOttawa scoring system, and contacted authors for the provision of additional data if needed. We combined results across studies by random-effects meta-analysis. This study is registered with PROSPERO, number CRD42016043227.Findings Five studies assessed the morphological eligibility for EVAR (1507 men, 400 women). The overall pooled proportion of women eligible (34%) for EVAR was lower than it was in men (54%; odds ratio [OR] 0·44, 95% CI 0·32-0·62). Four single-centre studies reported non-intervention rates (1365 men, 247 women). The overall pooled non-intervention rates were higher in women (34%) than men (19%; OR 2·27, 95% CI 1·21-4·23). The review of 30-day mortality included nine studies (52 018 men, 11 076 women). The overall pooled estimate for EVAR was higher in women (2·3%) than in men (1·4%; OR 1·67, 95% CI 1·38-2·04). The overall estimate for open repair also was higher in women (5·4%) than in men (2·8%; OR 1·76, 95% CI 1·35-2·30).Interpretation Compared with men, a smaller proportion of women are eligible for EVAR, a higher proportion of women are not offered intervention, and operative...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Ulug¹,

Sweeting²,

vonAllmen³

et al. 2017

Journal of Vascular Surgery

View full text Add to dashboard Cite

show abstract

“…Diferences in AAA rupture and progression between men and women could relate to vascular anatomy. For example, Lo and Schermerhorn noted that if the ratio of infrarenal to suprarenal diameter is ≥1.2 or a deinition of ≥1.5 times the normal aortic diameter, then AAA prevalence in women could be as high as 6.2-9.8% [21]. This would indicate that using the same vascular anatomic criteria for men and women could lead to underdiagnosis of small AAAs in women [21].…”

Section: Sex Diferences In Aaa Prevalence In Human and Experimental Mmentioning

confidence: 99%

“…For example, Lo and Schermerhorn noted that if the ratio of infrarenal to suprarenal diameter is ≥1.2 or a deinition of ≥1.5 times the normal aortic diameter, then AAA prevalence in women could be as high as 6.2-9.8% [21]. This would indicate that using the same vascular anatomic criteria for men and women could lead to underdiagnosis of small AAAs in women [21]. While there is general consensus that men should be screened at 65 years of age or older, only the Society for Vascular Surgery recommends screening women (65 or older) who have smoked or have a family history of AAA [21].…”

Section: Sex Diferences In Aaa Prevalence In Human and Experimental Mmentioning

confidence: 99%

“…This would indicate that using the same vascular anatomic criteria for men and women could lead to underdiagnosis of small AAAs in women [21]. While there is general consensus that men should be screened at 65 years of age or older, only the Society for Vascular Surgery recommends screening women (65 or older) who have smoked or have a family history of AAA [21]. In fact, some studies have indicated that women who smoke are more likely than nonsmoking men to develop AAAs [22].…”

Section: Sex Diferences In Aaa Prevalence In Human and Experimental Mmentioning

confidence: 99%

See 1 more Smart Citation

Sexual Dimorphism of Abdominal Aortic Aneurysms

Alsiraj¹,

Thatcher²,

Cassis³

2017

Aortic Aneurysm

View full text Add to dashboard Cite

Sex is the largest nonmodiiable risk factor for the development of abdominal aortic aneurysms (AAAs) in humans and experimental models. Data from several studies consistently demonstrate a higher AAA prevalence in males than in females, contributing to divergent recommendations for AAA screening in men and women. Despite a higher AAA prevalence in males, females have more rapid rates of aneurysm dilation, and aneurysms rupture at smaller sizes. Unfortunately, no therapies have been efective to retard aneurysm dilation in either sex. Results from experimental AAA models indicate a protective role for estrogen in AAA development and progression, while male testosterone has been demonstrated to markedly promote angiotensin II (AngII)-induced AAAs. Potential mechanisms implicated in sex hormone regulation of AAAs include regulation of inlammation, matrix metalloproteinases, aromatase activity, oxidative stress, stem cells, and transforming growth factor-beta. In addition to sex hormones, sex chromosomes have been implicated in diseases of the aorta. Turner's syndrome (monosomy X) patients have a high incidence of thoracic aortic rupture. Recent studies indicate a novel approach to deine the relative role of sex hormones versus sex chromosomes in experimental AAAs. Further studies are warranted to determine interactions between sex hormones and sex chromosomes in AAA development and progression.

show abstract

Updated Guidelines on Screening for Abdominal Aortic Aneurysms

Freischlag

2019

JAMA

View full text Add to dashboard Cite

In this issue of JAMA, the US Preventive Services Task Force (USPSTF) has updated its previous 2014 recommendations on screening asymptomatic adults for abdominal aortic aneurysm (AAA). 1 In addition, an updated evidence report and systematic review 2 accompanies this report from the USPSTF. These recommendations are not substantially different from the previously published recommendations. 3 The USPSTF recommends that men aged 65 to 75 years who have ever smoked receive a 1-time screening for AAA with ultrasonography (B recommendation), as the prevalence is highest in this population-estimated to be 7%. This recommendation is based on 4 large population-based randomized clinical trials from the United Kingdom, Denmark, and Australia that found screening for AAA among men led to a decrease in AAArelated mortality and in emergency surgery for aortic rupture. The moderate net benefit also relates to the improved outcomes of interventions for AAA in this population, involving either endovascular or open repair. Reports indicate that 80% of elective aortic aneurysm repairs and 54% of operations for aneurysm rupture are now performed using endovascular repair, which has a lower perioperative mortality than open repair. 4,5 The USPSTF also recommends that men aged 65 to 75 years who have never smoked be selectively screened for AAA with ultrasonography (C recommendation), as the net benefit is small because the prevalence of AAA is only 2% in this population. This recommendation is based in part on information from the Aneurysm Detection Management Study (ADAM), in which patients aged 50 to 79 years with an AAA 4.0 to 4.5 cm in diameter were randomly assigned to immediate repair or surveillance. Among 126 196 patients screened in this study, 2262 were found to have an AAA and an additional 2376 patients were referred, for a total of 5038 patients eligible for the trial based on the size of their AAA. Only 1136 (23%) underwent randomization, because 1466 (29%) declined evaluation, 125 (2%) were eligible and declined randomization, and 2311 (46%) were excluded because of medical comorbidities that precluded their candidacy for an open repair, because endovascular repair was not yet available. 6 Even with endovascular repair available for the patients with greater severity of illness, emphasis has been on survival following the procedure, given the competing risk of other coexisting diseases leading to early death following the procedure. Endovascular repair is much more expensive

show abstract

Abdominal aortic aneurysms in women

Cited by 133 publications

References 67 publications

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

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

Sexual Dimorphism of Abdominal Aortic Aneurysms

Updated Guidelines on Screening for Abdominal Aortic Aneurysms

Contact Info

Product

Resources

About