Women with abdominal aortic aneurysms have far worse outcomes than men, and their treatment needs to be dramatically improved, British researchers report.
An abdominal aortic aneurysm occurs when there is weakening and ballooning of the wall of the aorta — the largest artery which carries blood from the heart through the abdomen to the rest of the body. Patients with the condition are at risk for a potentially life-threatening rupture.
The researchers reviewed international studies conducted since 2000 and found that women with abdominal aorta aneurysm fare worse than men at every stage of treatment. Women are less likely to be offered surgery to repair the problem, including keyhole surgery, which is linked with better outcomes.
The keyhole technique, considered to be minimally invasive, involves inserting a tube-like graft through the leg artery to repair the weakened aorta. “Open” surgery involves going into the abdomen to replace the ballooning section of the aorta with a tube-like graft, according to background notes with the study.
“Our findings show that despite overall improvement in mortality rates for this condition, there is a huge disparity between outcomes for men and women, which is not acceptable,” said study leader Janet Powell, surgery and cancer professor at Imperial College London.
“Abdominal aortic aneurysm is still seen as mainly a male condition, and as a result, the way we manage the condition — from screening to diagnosis and treatment — has been developed with men in mind. Our study shows that this needs to change,” she said in a college news release.
Powell and her colleagues reviewed several studies. Less than one-fifth of men were not offered surgery, compared with one-third of women. Only one-third of women were considered eligible for keyhole surgery, compared with just over half of men, the researchers found.
Death rates 30 days after keyhole surgery were 2.3 percent for women and 1.4 percent for men. Death rates 30 days after open surgery were 5.4 percent for women and 2.8 percent for men, the review found.
The findings were published April 25 in The Lancet.
Women tend to develop aneurysms at an older age than men, and their aortas are smaller. Both factors can affect whether surgery is an option and which type of surgery is suitable, according to the researchers.
However, age and physical fitness are not enough to account for the differences in death rates between men and women, the investigators said.
“The way abdominal aortic aneurysm is managed in women needs urgent improvement. We need to see if the devices used for keyhole surgery can be made more flexible to enable more women to be offered this option. We also need more grafts designed to fit women, who have smaller aortas, as all the grafts currently available have been designed for men,” Powell said.
The American Academy of Family Physicians has more on abdominal aortic aneurysm.