Epidemiology, Aetiology, Risk of Rupture and Treatment of Abdominal Aortic Aneurysms: Does Sex Matter?

• Published in: European journal of vascular and endovascular surgery Vol. 38; no. 3; pp. 278 - 284
• Main Authors: Grootenboer, N, Bosch, J.L, Hendriks, J.M, van Sambeek, M.R.H.M
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-09-2009
• Subjects: Abdominal aortic aneurysm; Aetiology; Aortic Aneurysm, Abdominal - etiology; Aortic Aneurysm, Abdominal - metabolism; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - pathology; Aortic Aneurysm, Abdominal - surgery; Aortic Rupture - etiology; Aortic Rupture - metabolism; Aortic Rupture - mortality; Aortic Rupture - pathology; Aortic Rupture - surgery; Down-Regulation; Epidemiology; Estrogens - metabolism; Female; Gender; Genetic Predisposition to Disease; Health Knowledge, Attitudes, Practice; Healthcare Disparities; Humans; Macrophages - enzymology; Male; Matrix Metalloproteinase 9 - metabolism; Practice Guidelines as Topic; Prevalence; Risk Assessment; Risk Factors; Rupture; Sex Factors; Surgery; Treatment; Treatment Outcome; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality; Women's Health; Treatment; Gender; Epidemiology; Aetiology; Abdominal aortic aneurysm; Rupture
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2009.05.004

Abstract Objectives To unravel the extent to which gender plays a role in the epidemiology, aetiology, risk of rupture and treatment of abdominal aortic aneurysms (AAAs) and to give an overview of these factors. Design, Materials and Methods A literature review was performed in the Medline database and Cochrane Library for gender-specific articles on epidemiology, aetiology, risk of rupture and treatment of AAAs. Results Our literature review suggests that the prevalence of AAA in women is underestimated. Regarding aetiology, an oestrogen-mediated reduction in macrophage MMP-9 production seems to be an important mechanism causing gender-related differences in AAA development. We found consensus in the literature that women run a greater risk of rupture compared to men under the current management rules for AAAs. Their treatment mortality also seems to be higher for both elective and ruptured repair. Conclusions Gender-specific guidelines should be put into place for the management of AAAs and awareness for this disease should be increased, both in women themselves and in their doctors.