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Abdominal Aortic Aneurysm Ruptures More Common in Women Than in Men

Symptoms, screening and monitoring should be done if risks are present

Each year more than 200,000 Americans get an abdominal aortic aneurysm (AAA) and 15,000 (75 to 90 percent) die from one. More men than women comprise the 5 to 7 percent of adults who are 60 years of age or older who have an AAA, however 2 to 3 percent of women who have an AAA have four times the risk of rupture than men.

The abdominal aorta (the largest artery in the abdomen) supplies blood to the lower part of the body. In the abdomen, just below the navel, the aorta splits into two branches, called the iliac arteries, which carry blood into each leg. As blood flows through abdominal aorta it can push and expand the artery wall causing it to weaken, enlarge and bulge out, creating an AAA.

If an AAA is found to be nearing five centimeters or larger the chance of rupture becomes significant and a vascular surgeon can repair it by open incision or a minimally-invasive procedure called an endovascular aneurysm repair (EVAR).

"Often women get aneurysmal disease occurs later in life due to hormonal and other factors," said Eva Rzucidlo, MD, a vascular surgeon at Dartmouth-Hitchcock Medical Center in Lebanon, NH, and chair of the Women's Leadership Committee at the Society for Vascular Surgery®. She added that females experience more with smaller aneurysms and worse outcomes than their male counterparts.

"Women are less likely to be offered EVAR to correct an AAA, mainly because they have smaller arteries and the current endovascular devices are made to fit the male anatomy," said Dr. Rzucidlo. "Females are more likely than males to die following open surgery; but when given the option of EVAR women have a death rate almost as low as men and respond by better displaying a more rapid shrinkage of their aneurysm."

"Patients may describe a pulsing feeling or pain in their abdomen that physicians can sometimes feel, or a sudden pain in the lower back, but most of the time aneurysms have no symptoms," added Dr. Rzucidlo. "Any sudden abdomen or back pain could be a sign or rupture and would require immediate medical attention."

Age, heart disease, and smoking are major risk factors that increase the chance of AAA and if a woman has all three her risk of AAA rupture can be as high as 7 percent. Other risks are hypertension, high cholesterol, obstructive pulmonary disease, and family history. Immediate relatives are at increased risk and if people have a sibling with an AAA their risk increases to five-fold.

"The normal size of an AAA is two centimeters," added Dr. Rzucidlo. "If larger, a screening can be monitored by a vascular surgeon every six months to a year by CT scan, ultrasound, magnetic resonance imaging (MRI), or sonogram. Blood pressure medication may be prescribed to lower the pressure on the weakened area of the aneurysm.

"The U.S. Preventive Service Task Force currently does not recommend screening for AAA in women," noted Dr. Rzucidlo. "According to some researchers this may be misguided, because AAA is somewhat less common in women and at the same time there are women with risk factors who deserve screening."

Dr. Rzucidlo added that SVS recommends abdominal ultrasound AAA screening for all men ages 60 to 85 years or people ages 50 and older with a history of AAA, as well as all women ages 60 to 85 years with cardiovascular risk factors.

About the Society for Vascular Surgery

The Society for Vascular Surgery® (SVS) is a not-for-profit professional medical society, composed primarily of vascular surgeons, that seeks to advance excellence and innovation in vascular health through education, advocacy, research, and public awareness. SVS is the national advocate for 4,008 specialty-trained vascular surgeons and other medical professionals who are dedicated to the prevention and cure of vascular disease.

Visit its Web site at www.VascularWeb.org
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