Soares Ferreira Rita, Gomes Oliveira Nelson, Oliveira-Pinto José, van Rijn Marie J, Ten Raa Sander, Verhagen Hence J, Bastos Gonçalves Frederico
Department of Angiology and Vascular Surgery, Hospital de Santa Marta, CHLC & NOVA Medical School, Lisbon, Portugal -
Department of Angiology and Vascular Surgery, Hospital do Divino Espírito Santo, Ponta Delgada, Azores, Portugal.
J Cardiovasc Surg (Torino). 2018 Apr;59(2):195-200. doi: 10.23736/S0021-9509.18.10380-6. Epub 2018 Jan 9.
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.
一般来说，血管手术，特别是腹主动脉瘤（AAA）修复手术，在女性患者中预后较差。然而，女性性别如何影响动脉瘤破裂情况下的预后仍不清楚，与择期手术相比可能更为明显。在本报告中，作者旨在回顾关于女性破裂性AAA修复的文献。使用传统的AAA最大直径阈值30毫米，女性中的患病率低于男性。然而，由于正常主动脉直径的性别差异，实际患病率可能被低估。对于女性来说，动脉瘤疾病似乎出现得较晚，合并症更多，并且在较小的主动脉直径时发生破裂。这对治疗有明显影响。对于女性破裂性AAA的最佳治疗方法仍未达成共识。她们接受血管内动脉瘤修复治疗的频率较低，可能是由于解剖学限制。在可行的情况下，血管内修复至少在短期内显示出更好的预后，并且有新证据表明也有持久益处。与男性相比，开放修复的结果普遍更差。最后，尽管获得了明显相似的医疗保健，但与男性相比，女性在破裂性AAA修复后的相对生存率较低。有必要进一步调查以确定这些差异的原因。
