Epidemiology, aetiology, risk of rupture and treatment of abdominal aortic aneurysms: does sex matter?
OBJECTIVE
To unravel the extent to which gender plays a role in the epidemiology, aetiology, risk of rupture and treatment of abdominal aortic aneurysms (AAAs) and to give an overview of these factors.


METHODS
A literature review was performed in the Medline database and Cochrane Library for gender-specific articles on epidemiology, aetiology, risk of rupture and treatment of AAAs.


RESULTS
Our literature review suggests that the prevalence of AAA in women is underestimated. Regarding aetiology, an oestrogen-mediated reduction in macrophage MMP-9 production seems to be an important mechanism causing gender-related differences in AAA development. We found consensus in the literature that women run a greater risk of rupture compared to men under the current management rules for AAAs. Their treatment mortality also seems to be higher for both elective and ruptured repair.


CONCLUSIONS
Gender-specific guidelines should be put into place for the management of AAAs and awareness for this disease should be increased, both in women themselves and in their doctors.
Grootenboer
N
N
Program for the Assessment of Radiological Technology (ART Program), Department of Epidemiology and Department of Radiology, Erasmus MC, Rotterdam, The Netherlands.
Bosch
J L
JL
Hendriks
J M
JM
van Sambeek
M R H M
MR
D017544:Aortic Aneurysm, Abdominal / Q000209:etiology / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000601:surgery; D001019:Aortic Rupture / Q000209:etiology / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015536:Down-Regulation; D004967:Estrogens / Q000378:metabolism; D005260:Female; D020022:Genetic Predisposition to Disease; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D006801:Humans; D008264:Macrophages / Q000201:enzymology; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism; D017410:Practice Guidelines as Topic; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016387:Women's Health
D004967:Estrogens; D020780:Matrix Metalloproteinase 9