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Talvitie, M; Åldstedt-Nyrønning, L; Stenman, M; Roy, J; Cohnert, T; Hultgren, R.
Women with large intact abdominal aortic aneurysms remain untreated.
J Vasc Surg. 2023; 78(3):657-667.e5 Doi: 10.1016/j.jvs.2023.05.025
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Co-authors Med Uni Graz: Cohnert Tina Ulrike
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Abstract:: OBJECTIVE: A lower elective repair rate among women with abdominal aortic aneurysms (AAAs) has been a consistent finding. Reasons behind this gender gap have not been thoroughly outlined. METHODS: This was a retrospective multicenter cohort study (ClinicalTrials.gov: NCT05346289) at three European vascular centers in Sweden, Austria and Norway. Patients in surveillance with AAAs were consecutively identified starting from January 1, 2014, until reaching a total sample size of 200 women and 200 men. All individuals were followed for 7 years through medical records. Final treatment distributions and the proportion of "truly untreated" (surgically untreated despite reaching guideline-directed thresholds: 50 mm for women and 55 mm for men) were determined. In a complementary analysis, a universal 55-mm threshold was used. Gender-specific primary reasons behind untreated statuses were clarified. Eligibility for endovascular repair among the truly untreated was assessed in a structured computed tomography analysis. RESULTS: Women and men had similar median diameters at inclusion (46 mm; P = .54) and at treatment decisions (55 mm; P = .36). After 7 years, the repair rate was lower among women (47% vs 57%). More women were truly untreated (26% vs 8%; P < .001) despite similar mean ages as for male counterparts (79.3 years; P = .16). With the 55-mm threshold, 16% women still classified as truly untreated. Similar reasons for nonintervention were captured for women and men (50% due to comorbidities alone, 36% morphology and comorbidity). The endovascular repair imaging analysis revealed no gender differences. Among truly untreated women, ruptures were common (18%), and mortality was high (86%). CONCLUSIONS: Surgical AAA management differed between women and men. Women could be underserved in terms of elective repairs: one in every four women was untreated with over-the-threshold AAAs. The lack of obvious gender differences in eligibility analyses could imply unmeasured discrepancies (eg, in disease extent or patient frailty).
Find related publications in this database (using NLM MeSH Indexing): Humans - administration & dosage; Male - administration & dosage; Female - administration & dosage; Aged - administration & dosage; Cohort Studies - administration & dosage; Endovascular Procedures - adverse effects; Retrospective Studies - administration & dosage; Aortic Aneurysm, Abdominal - diagnostic imaging, epidemiology, surgery; Blood Vessel Prosthesis Implantation - administration & dosage; Risk Factors - administration & dosage; Aortic Rupture - surgery; Treatment Outcome - administration & dosage
Find related publications in this database (Keywords): Abdominal; Aortic aneurysm; Aortic rupture; Conservative treatment; Eligibility Determination; Mortality; Women