Skibba Afshin A, Evans James R, Hopkins Steven P, Yoon H Richard, Katras Tony, Kalbfleisch John H, Rush Daniel S
Division of Vascular Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tenn.
Division of Vascular Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tenn.
J Vasc Surg. 2015 Dec;62(6):1429-36. doi: 10.1016/j.jvs.2015.07.079. Epub 2015 Sep 26.
Abdominal aortic aneurysms (AAAs) may rupture at smaller diameters in women than in men, and women may be at higher risk and have poorer outcomes in elective and emergent interventions because of age and comorbidities. Practice guidelines recommending elective AAA repair at >5.5 cm are gender neutral and may not adequately reflect increased risks in women or the potential advantages of elective lower risk endovascular procedures.
Patients with a diagnosis of AAA discharged from a single referral hospital during a 14-year period were identified for retrospective analysis.
A total of 2121 patients with AAAs were studied, 499 women (23.5%) and 1622 men (76.5%). Women were older and had a greater incidence of hypertension, smoking, chronic obstructive pulmonary disease, dyslipidemia, and renal insufficiency. Intact AAAs in 467 women had a mean diameter of 4.4 ± 1.3 cm compared with 1538 men at 5.0 ± 1.4 cm (P < .01). The ruptured AAAs in 32 women (6.4%) had a mean diameter of 6.1 ± 1.5 cm compared with 84 men (5.2%) at 7.7 ± 1.9 cm (P < .01). Women had a twofold increased frequency of AAA rupture than men at all size intervals (P < .01). The frequency of ruptured AAAs <5.5 cm among 10 of 32 women with ruptured AAAs was 31.3%; among 7 of 84 men with ruptured AAAs, it was 8.3% (P < .01). The frequency of ruptured AAAs <5.5 cm in all 383 women with AAAs <5.5 cm was 2.6%; in 1042 men, it was 0.6% (P < .01). Of the 1211 AAA repairs, 574 (47.4%) were open aneurysm repair (OAR) and 637 (52.6%) were endovascular aneurysm repair (EVAR). Mortality after elective OAR in 475 patients of both sexes was 5.1%; for EVAR in 676 patients, mortality was 1.6% (P < .01). No differences in mortality with respect to OAR or EVAR were found between the female and male cohorts in either intact or ruptured AAAs.
Women with AAAs are older and have a higher frequency of cardiovascular risk factors than men. Women rupture AAAs with a greater frequency than men at all size intervals and have a fourfold increased frequency of rupture at <5.5 cm. No differences in surgical mortality between women and men were found. Current practice guidelines for elective AAA operative intervention should be reconsidered and stratified by gender.
腹主动脉瘤（AAA）在女性中可能在比男性更小的直径时破裂，并且由于年龄和合并症，女性在择期和急诊干预中可能风险更高且预后更差。推荐在直径>5.5 cm时进行择期AAA修复的实践指南是性别中立的，可能无法充分反映女性增加的风险或择期低风险血管内手术的潜在优势。
确定在14年期间从一家单一转诊医院出院的诊断为AAA的患者进行回顾性分析。
共研究了2121例AAA患者，其中499例女性（23.5%）和1622例男性（76.5%）。女性年龄更大，高血压、吸烟、慢性阻塞性肺疾病、血脂异常和肾功能不全的发生率更高。467例女性未破裂AAA的平均直径为4.4±1.3 cm，而1538例男性为5.0±1.4 cm（P<.01）。32例女性破裂AAA的平均直径为6.1±1.5 cm，而84例男性为7.7±1.9 cm（P<.01）。在所有尺寸区间，女性AAA破裂的频率是男性的两倍（P<.01）。32例破裂AAA的女性中有10例（31.3%）AAA破裂直径<5.5 cm；84例破裂AAA的男性中有7例（8.3%），差异有统计学意义（P<.01）。在所有383例AAA直径<5.5 cm的女性中，AAA破裂频率为2.6%；1 in 1042男性中，这一比例为0.6%（P<.01）。在1211例AAA修复手术中，574例（47.4%）为开放性动脉瘤修复（OAR），637例（52.6%）为血管内动脉瘤修复（EVAR）。475例男女患者择期OAR后的死亡率为5.1%；676例患者进行EVAR后的死亡率为1.6%（P<.01）。在未破裂或破裂的AAA中，女性和男性队列在OAR或EVAR方面的死亡率没有差异。
患有AAA的女性年龄更大，心血管危险因素的频率高于男性。在所有尺寸区间，女性AAA破裂的频率高于男性，在直径<5.5 cm时破裂频率增加四倍。未发现女性和男性手术死亡率的差异。当前关于择期AAA手术干预的实践指南应重新考虑并按性别分层。
