Variation in Death Rate After Abdominal Aortic Aneurysmectomy in the United States

Dimick, Justin B.; Stanley, James C.; Axelrod, David A.; Kazmers, Andris; Henke, Peter K.; Jacobs, Lloyd A.; Wakefield, Thomas W.; Greenfield, Lazar J.; Upchurch, Gilbert R.

doi:10.1097/00000658-200204000-00017

Cited by 175 publications

(147 citation statements)

References 22 publications

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“…23,26 In addition, AAAs in women occur nearly a decade later than they do in men, although they are more often juxtarenal compared with infrarenal AAAs. 27 Nonetheless, women have up to 4 times the risk of rupture and death compared with men, 28,29 and have nearly 3-times the complication rate after AAA repair compared with men. 30 Thus, whereas AAAs occur more frequently in men, the clinical sequelae of this disease in women are more disastrous.…”

Section: Discussionmentioning

confidence: 99%

Gender Differences in Experimental Aortic Aneurysm Formation

Ailawadi

Eliason

Roelofs

et al. 2004

ATVB

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Objective-It is hypothesized that a male predominance, similar to that in humans, persists in a rodent model of experimental abdominal aortic aneurysm (AAA) via alterations in matrix metalloproteinases (MMPs). Methods and Results-Group I experiments were as follows: elastase perfusion of the infrarenal aorta was performed in male (M) and female (F) rats. At 14 days, aortas were harvested for immunohistochemistry, real-time polymerase chain reaction (PCR), and zymography. Group II experiments were the following: abdominal aorta was transplanted from F or M donors into F or M recipients. At 14 days, rodents that had undergone transplantation underwent elastase perfusion. In group III, male rats were given estradiol or sham 5 days before elastase perfusion. In group I, M rats had larger AAAs with higher frequency than did F rats. M rat aortas had more significant macrophage infiltrates and increased matrix metalloproteinase (MMP)-9 production and activity. In group II, M-to-M aortic transplants uniformly developed aneurysms after elastase perfusion, whereas F-to-F aortic transplants remained resistant to aneurysm formation. F aortas transplanted into M recipients, however, lost aneurysm resistance. In group III, estradiol-treated rats demonstrated smaller aneurysms and less macrophage infiltrate and MMP-9 compared with M controls after elastase. Conclusions-These data provide evidence of gender-related differences in AAA development, which may reflect an estrogen-mediated reduction in macrophage MMP-9 production.

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Section: Discussionmentioning

confidence: 99%

Gender Differences in Experimental Aortic Aneurysm Formation

Ailawadi

Eliason

Roelofs

et al. 2004

ATVB

Self Cite

167

147

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“…Women undergoing elective open surgery for AAA are, on average, Ϸ2 years older than men. 5,6,32 Some population-based studies have found that the case fatality after elective surgery is 35% to 50% higher in women than in men, 6,35 although other studies have found no difference. 5,64,65 In a population-based study, the relative survival at 5 years after elective surgery is worse for women than men.…”

Section: Gender and Treatmentmentioning

confidence: 99%

“…32 Female gender is also an independent predictor (hazard ratio, 1.69; 95% CI, 1.28 to 2.22) of in-hospital death after surgery for ruptured AAA. 35 Although women presenting with ruptured AAA are on average 5 years older than men (Ϸ80 versus Ϸ75 years), most of these adverse outcomes are independent of age. 32,34 In summary, the risk of rupture and the likelihood of a poor outcome after rupture are greater in women than in men.…”

Section: Natural History: Expansion and Rupturementioning

confidence: 99%

Abdominal Aortic Aneurysm

2007

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M ost manifestations of cardiovascular disease are more common in men than in women. However, cardiovascular disease is the most common cause of death in women worldwide. 1 Coronary heart disease in women has a worse outcome than in men, and this has attracted considerable attention in recent years, with calls for more gender-specific research. 1,2 Abdominal aortic aneurysms (AAAs) also are less common in women than in men, and, as with coronary heart disease, there is evidence that women with AAA also have a worse prognosis. The present review addresses the epidemiology, development, natural history, management, and outcomes of AAA in women. Prevalence and IncidenceWhen the definition of a maximum external diameter Ն3 cm is used, the prevalence of AAA is up to 6 times greater in men than in women. 3,4 In a community-based screening study of the older population, the prevalence of AAA was 1.3% in women compared with 7.6% in men. 4 Similarly, the ratio of men to women in surgical series is Ϸ5:1. 5-7 Because of the relatively low prevalence, women were excluded from the large trials of screening for AAA. 8 -10 The prevalence in women from families with a strong history of AAA may be as high as 8.3%, and these women should be offered screening. 11 Modeling studies have indicated that screening for AAA in women could be cost-effective because the rupture rate appears to be much higher in women than in men. 12 The incidence of AAA has continued to rise over the last 4 decades. [13][14][15][16] Initially, a similar pattern was seen in both genders, although the increase in mortality and admission rate has been become more marked in women. 15,16 Inspection of data derived from national (England and Wales) statistics shows that the annual number of hospital admissions for aneurysm rupture between 1997 and 2005 has declined by 2% to 3% per annum in men. 17 In women, although the total number of admissions for ruptured AAA is Ϸ40% of male admissions, there has been an increase of Ϸ0.5% per annum since 2005. The reasons for this are unknown. Population screening for AAA in men is not yet widespread in England and Wales and is unlikely to have made a major contribution to these trends. However, AAA appears to be a late event after smoking exposure, and these trends may reflect temporal changes in smoking prevalence. The rise of smoking in women occurred over the period 1950 to 1970, several decades after the widespread uptake of smoking by men. Since then, rates of cessation have been greater in men than in women. 18 The presence of an AAA is associated with aneurysms of the iliac, femoral, and popliteal arteries, but, compared with AAA, all of these have a higher incidence ratio in men versus women. 19 However, some aneurysms are found predominantly or equally in women, with splenic 20 and cerebral artery 21 aneurysms being respective examples. Natural History: Expansion and RuptureThere is no good evidence to suggest that aneurysm growth rate is different in men and women. 22 Although a single small study suggested that ...

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“…Furthermore, mean AP diameter preceding rupture was significantly lower in women than men 26 . A number of other authors have reported a higher growth and rupture rate of AAA in women [27][28][29][30][31][32][33] . A Finnish community-based follow-up study reported that the aortic diameter was less than 5·5 cm in 24 per cent of women with a ruptured AAA, compared with only 5 per cent of men 21 .…”

Section: Targeted Screening For Aaamentioning

confidence: 91%