Women with aortic aneurysms fare much worse than men, new study finds

April 25, 2017

The findings, published today in The Lancet, show women fare worse than men at every stage of treatment, leading to the study's authors to call for urgent improvement in how the condition is managed in women.

The researchers, from Imperial College London and the University of Cambridge, found that women are less likely than men to be deemed suitable for keyhole surgery for the condition, which is associated with better outcomes. They are also more likely to be offered no surgical treatment at all. The findings are based on a review of international research into the condition, carried out since 2000.

An abdominal aortic aneurysm is caused by a weakening in the wall of the aorta, the body's largest blood vessel, which carries blood from the heart through the abdomen to the rest of the body. Degenerative changes in the aortic wall cause weakening and ballooning of the blood vessel, sometimes to more than three times its normal diameter, with a risk of a potentially life-threatening rupture.

Surgical repair for these aneurysms is offered only when the swelling is large enough to make the risk of rupture greater than the risks of the operation, with two types of surgery available.

Open surgery involves cutting into the abdomen and replacing all of the ballooning section of the aorta with a tube-like graft.

The second procedure, endovascular repair, is a minimally invasive 'keyhole' technique which involves inserting a tube-like graft through the leg artery into the swollen section of the aorta to reinforce the blood vessel's weakened wall. It is associated with better early outcomes than open surgery, but can only be offered when the aneurysm meets certain criteria, due to the shape and size of the grafts.

For some patients with large aneurysms, the risk of both of these options are deemed to outweigh the risk of rupture and no treatment is offered unless patient fitness can be improved.

The study, funded by the National Institute for Health Research, found that only a third of women were deemed suitable for keyhole surgery, compared with just over half of men. Less than a fifth of men were not offered surgery, compared with a third of women.

Mortality rates for women for the 30 days after keyhole surgery were 2.3 per cent compared with 1.4 per cent for men. For open surgery, this rose to 5.4 per cent for women and 2.8 per cent for men.

Women tend to develop aneurysms at an older age than men, and their aortas are smaller. Given the current technologies available, both of these factors can affect which type of surgery is deemed suitable, or whether surgery is an option at all. The researchers say that while these factors will form the basis of future research, age and physical fitness are not enough to account for the differences seen in mortality between men and women.

Professor Janet Powell, from Imperial's Department of Surgery & Cancer and who led the research, said: "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.

"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."

In the UK, abdominal aortic aneurysm is more prevalent in men, with men over 65 regularly screened for the condition. The condition often has no symptoms and many women are only diagnosed when the aneurysm ruptures, at which point the likelihood of survival can be less than 20 per cent.

Professor Powell added: "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."
'Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis' by Ulug, P et al, is published in The Lancet.

Imperial College London

Related Mortality Articles from Brightsurf:

Being in treatment with statins reduces COVID-19 mortality by 22% to 25%
A research by the Universitat Rovira i Virgili (URV) and Pere Virgili Institut (IISPV) led by LluĂ­s Masana has found that people who are being treated with statins have a 22% to 25% lower risk of dying from COVID-19.

Mortality rate higher for US rural residents
A recent study by Syracuse University sociology professor Shannon Monnat shows that mortality rates are higher for U.S. working-age residents who live in rural areas instead of metro areas, and the gap is getting wider.

COVID-19, excess all-cause mortality in US, 18 comparison countries
COVID-19 deaths and excess all-cause mortality in the U.S. are compared with 18 countries with diverse COVID-19 responses in this study.

New analysis shows hydroxychloroquine does not lower mortality in COVID-19 patients, and is associated with increased mortality when combined with the antibiotic azithromycin
A new meta-analysis of published studies into the drug hydroxychloroquine shows that it does not lower mortality in COVID-19 patients, and using it combined with the antibiotic azithromycin is associated with a 27% increased mortality.

Hydroxychloroquine reduces in-hospital COVID-19 mortality
An Italian observational study contributes to the ongoing debate regarding the use of hydroxychloroquine in the current pandemic.

What's the best way to estimate and track COVID-19 mortality?
When used correctly, the symptomatic case fatality ratio (sCFR) and the infection fatality ratio (IFR) are better measures by which to monitor COVID-19 epidemics than the commonly reported case fatality ratio (CFR), according to a new study published this week in PLOS Medicine by Anthony Hauser of the University of Bern, Switzerland, and colleagues.

COVID-19: Bacteriophage could decrease mortality
Bacteriophage can reduce bacterial growth in the lungs, limiting fluid build-up.

COPD and smoking associated with higher COVID-19 mortality
Current smokers and people with chronic obstructive pulmonary disease (COPD) have an increased risk of severe complications and higher mortality with COVID-19 infection, according to a new study published May 11, 2020 in the open-access journal PLOS ONE by Jaber Alqahtani of University College London, UK, and colleagues.

Highest mortality risks for poor and unemployed
Large dataset shows that income, work status and education have a clear influence on mortality in Germany.

Addressing causes of mortality in Zambia
Despite the fact that people in sub-Saharan Africa are now living longer than they did two decades ago, their average life expectancy remains below that of the rest of the world population.

Read More: Mortality News and Mortality Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.