REVIEW  OUTCOMES AND CHALLENGES IN MODERN AAA REPAIR 

The Journal of Cardiovascular Surgery 2018 April;59(2):195-200

DOI: 10.23736/S0021-9509.18.10380-6

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Review on management and outcomes of ruptured abdominal aortic aneurysm in women

Rita SOARES FERREIRA ¹ ✉, Nelson GOMES OLIVEIRA ^{2, 3}, José OLIVEIRA-PINTO ^{3, 4}, Marie J. van RIJN ³, Sander TEN RAA ³, Hence J. VERHAGEN ³, Frederico BASTOS GONÇALVES ¹

¹ Department of Angiology and Vascular Surgery, Hospital de Santa Marta, CHLC & NOVA Medical School, Lisbon, Portugal; ² Department of Angiology and Vascular Surgery, Hospital do Divino Espírito Santo, Ponta Delgada, Azores, Portugal; ³ Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands; ⁴ Department of Angiology and Vascular Surgery, Hospital de São João, Porto, Portugal

Vascular procedures in general, and specifically abdominal aortic aneurysm (AAA) repair, are associated with worse outcomes in female patients. However, how female gender influences outcomes in the setting of aneurysm-rupture remains unclear and may be even more pronounced when compared to elective operations. In this report, the authors aim to review the literature regarding ruptured AAA repair in women. Using the traditional threshold for AAA of 30 mm of maximum diameter, the prevalence in women is lesser than in men. However, the true prevalence may be underestimated due to gender discrepancies in normal aortic diameter. For females, aneurysmal disease seems to manifest later, have more associated comorbidities, and rupture occurs at smaller aortic diameters. This has obvious implications for management. There is still no consensus over the optimal treatment for ruptured AAA in women. They are less frequently treated by endovascular aneurysm repair, possibly due to anatomical restrains. When feasible, endovascular repair shows better outcomes, at least in the short-term, and there is new evidence suggesting a lasting benefit as well. For open repair the results are consensually worse when compared to male counterparts. Finally, despite benefitting of apparently similar healthcare, women have a lower relative survival after rAAA repair when compared to men. Further investigation to determine the reasons of these discrepancies is warranted.

KEY WORDS: Aortic aneurysm, abdominal - Rupture - Women - Treatment outcome