Malayala Srikrishna Varun, Raza Ambreen, Vanaparthy Rachana
Department of Medicine, Temple University Health System, Philadelphia, PA, USA.
Department of Medicine, Bristol Hospital, Farmington, CT, USA.
J Clin Med Res. 2020 Dec;12(12):794-802. doi: 10.14740/jocmr4376. Epub 2020 Dec 18.
Annually, 5% of sudden deaths are due to abdominal aortic aneurysm (AAA) rupture. There is evidence suggesting that AAA ruptures have worse outcomes in females than males and the aneurysms rupture at a smaller size in females than in males. The United States Preventive Services Task Force (USPSTF) recommends a one-time ultrasound screening for males aged 65 - 75 years who ever smoked. There is insufficient evidence to screen females aged 65 - 75 years who ever smoked though there is evidence suggesting that AAAs rupture at a smaller size and have worse outcomes in females. The objective of this study is to compare the characteristics, mortality and morbidity of ruptured AAAs in females and males.
This is a retrospective review of 117 patients from two teaching institutions over a period of 6 years. A total of 39 parameters were compared between males and females including demographic variables, comorbidities like hypertension, dyslipidemia, cardiovascular diseases; previous history of AAA; medications, characteristics of aneurysm, type of surgery and its outcome; postoperative complications and long-term survival.
The overall incidence of AAA rupture was higher in males (68%) than in females (32%). Females die from AAA rupture at a later age. There was a significant difference in the size of AAA rupture between females (mean = 7.4 cm, standard deviation (SD) = 2.0) and males (mean = 8.2 cm, SD = 1.8; P = 0.04). The probability to undergo surgery for ruptured AAA was significantly lower for females as compared to males (P = 0.03). Females had higher overall mortality (P = 0.001), postoperative mortality (P = 0.02), higher length of intensive care unit (ICU) stay, incidence of postoperative complications, use of vasopressors and use of ventilator.
Using a similar threshold of size of AAA for elective surgery for both males and females might not be appropriate. Further population-based studies are needed to warrant AAA screening for high-risk females owing to the higher morbidity and mortality.
每年，5%的猝死是由腹主动脉瘤（AAA）破裂所致。有证据表明，AAA破裂在女性中的后果比男性更严重，且女性动脉瘤破裂时的尺寸比男性更小。美国预防服务工作组（USPSTF）建议对年龄在65至75岁且曾经吸烟的男性进行一次性超声筛查。尽管有证据表明AAA在女性中破裂时尺寸更小且后果更严重，但对于年龄在65至75岁且曾经吸烟的女性进行筛查的证据不足。本研究的目的是比较女性和男性破裂性AAA的特征、死亡率和发病率。
这是一项对来自两个教学机构的117例患者进行的为期6年的回顾性研究。对男性和女性之间的39项参数进行了比较，包括人口统计学变量、合并症如高血压、血脂异常、心血管疾病；AAA既往史；药物治疗、动脉瘤特征、手术类型及其结果；术后并发症和长期生存情况。
AAA破裂的总体发生率男性（68%）高于女性（32%）。女性死于AAA破裂的年龄更大。女性（平均 = 7.4 cm，标准差（SD）= 2.0）和男性（平均 = 8.2 cm，SD = 1.8；P = 0.04）之间AAA破裂的尺寸存在显著差异。与男性相比，女性因破裂性AAA接受手术的概率显著更低（P = 0.03）。女性的总体死亡率更高（P = 0.001）、术后死亡率更高（P = 0.02）、重症监护病房（ICU）住院时间更长、术后并发症发生率更高、血管加压药使用情况和呼吸机使用情况更多。
对男性和女性择期手术采用相似的AAA尺寸阈值可能并不合适。由于发病率和死亡率更高，需要进一步开展基于人群的研究以确保对高危女性进行AAA筛查。
