Abdominal Aortic Aneurysm – More Common In Men, More Dangerous In Women
Abdominal aortic aneurysms in women are known to be more aggressive than in men. In women abdominal aortic aneurysms expand more rapidly and are more prone to rupture. Abdominal aortic aneurysms in women are also associated with a higher death when they rupture.
Men are much more likely to have an abdominal aortic aneurysm than women. Up to 5% of men may have an abdominal aortic aneurysm compared to up to 1% of women. The standard definition of an abdominal aortic aneurysm is a diameter of ≥ 30mm, a definition that may lead to underestimating the true number of significant aneurysms in woman.
Abdominal aortic aneurysms are more aggressive in women. They grow faster, there are more likely to rupture and they are more likely to result in death when they rupture. The rupture typically occurs at smaller aorta sizes when compared to men. Unfortunately, fewer women undergo repair once they present with rupture, which likely further contributes to the poor outcomes seen in women.
Risk Factors For Abdominal Aortic Aneurysm In Woman
Risk factors for the development of abdominal aortic aneurysm include many of the classic risk factors for cardiovascular disease such as age, smoking, blood pressure etc.
Abdominal aortic aneurysm is a result of degeneration of the wall of the aorta. The wall of the aorta is made up of many different cell types that are surrounded by a matrix that acts as a scaffold. There is a complex interplay going on at all times between cells that build up the wall and scaffold and cells that break this down. In aneurysm formation, experimental studies suggest that there is inflammation and activation of cells break down the aortic wall and weaken it. It is also felt that estrogen in women plays a protective role against aneurysm formation while in men, male hormones can be somewhat destructive.
Should Woman Be Routinely Tested For Abdominal Aortic Aneurysm?
In men, ultrasound scans of the abdomen have been demonstrated as an effective method of screening for abdominal aortic aneurysm. Current guidelines from the leading societies recommend a one time screening ultrasounds to all men 65 or older who have ever smoked or who have a family history of abdominal aortic aneurysm. Amazingly there are no current widespread recommendations for screening women with ultrasound. This is mainly due to a lack of evidence as most the research has been done on men and the data regarding women is mixed in its findings. Some recommendations are against screening women as they say it would not be effective whereas others recommend screening woman age 65 or older that have smoked or have had a family history of abdominal aortic aneurysm.
Should Abdominal Aortic Aneurysm Be Fixed Earlier In Women?
Since aneurysms are more likely to rupture in women even at a smaller size, there is a debate over whether abdominal aortic aneurysms should be fixed earlier in women. In trials looking at fixing abdominal aortic aneurysms earlier in the population in general, women were underrepresented and so it’s difficult to draw conclusions. It’s important to note that when women undergo surgery in general for abdominal aortic aneurysm that they have worse outcomes as compared to men. For this reason many people feel that it is not appropriate to operate earlier than the standard recommendations in women.
How Are Abdominal Aortic Aneurysms Fixed In Women?
As things stand the minimally invasive, non surgical, EVAR has become the mainstay of treatment for abdominal aortic aneurysm, however some studies report that in women the outcomes are significantly worse as compared to men. Other studies however report similar results of EVAR in men and women.
There have been may suggested reasons for women doing worse in general after procedures for abdominal aortic aneurysm. Women typically develop abdominal aortic aneurysm at a later age and are also less likely to receive attention to risk factors such as smoking, blood pressure and cholesterol. When undergoing repair with EVAR, women are more likely to have access site complications such as damage to the leg vessels through which the procedure is performed. This is likely because women have smaller leg vessels in general.
I just found out I have ascending aorta dilation of 3.8and the a. root is dilated 3.7, getting a nuclear test soon. in the meantime do I need to do something like not exercise?
That is mild dilation only and likely just requires observation. The nuclear test is unrelated. See what the cardiologist says after assessment.
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No. Don’t exercise it may rupture. Take small breaths often and do less stressful work.
My sister has a AAA and it’s at a 7,they doing nuclear stress Monday,which I’m against plus 2 more unsure what they are.
My mom was just diagnosed with an aortic
aneurysm. Im not sure if it is abdominal or thoracic but she is almost 89 and still able to continue her normal routine. However she was also diagnosed with a 2.5cm growth in the bladder which may be cancer. We now have to postpone the procedure due to the new finding. We are now left with deciding Which of these conditions we treat first and if she survives the procedure what her quality of life will be afterwards. This aging process is not kind to anyone unfortunately. What to do?🤔🙏
Can you slow the calcification of a mitral valve. I also have a 3.7 aortic aneurysm.
This is very concerning as it came out of the blue.
Any recommendations. ?
Thank you Sincerely
Angie
I presently have an abdoninial, aoratic measuring 4.4.
It that too small to be fixed with surgery?.
Is there any precautions I can take for it.
I’ve just been diagnosed wit an AAA at 3.2cm, had a scan 3 months later and its 3.5cm. I’ve got severe vascular disease and had a life saving operation on my abdominal aorta almost 5 years ago. It was almost completely blocked from my kidneys down, which resulted in me losing my right kidney. I had a Dacron graft inserted giving me blood flow to both legs. I was 54 when this happened. This AAA was found by chance, now waiting to see what will happen. I know it’s only got bigger by 0.3cm in 3 months and wondering if that’s normal???
I am a 73-yr-old woman. Last week I was diagnosed with a 4.9 size aortic aneurysm. I have been referred to a vascular surgeon though i haven’t received a call from his office yet. I am quite stressed about this. I am wondering if surgery will be done at my age or ?
It’s the 21st century and women are still getting the short end of the diagnostic scheme, still more often, “hysterical” and undeserving? of research studies, changes in protocols, etc. Even the equipment utilized for various procedures for women are not designed for women. Thank you for the article.
I agree with you Jane. It’s frightening.
My father and his three brothers all had AAA ( familial AAA). My brothers will be tested but as his daughter, should I also be tested?
A baseline screening test seems sensible.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
My mom had an 8cm AAA. It ruptured and she died. Had stents, a pace maker, became anemic had weird abdominal pain oh and was a smoker for 40 years before heart attack. Followed by her PMD/cardiologist and hematologist. No one ever gave her the 15 minute US that could have saved her life years before. Do you think her family wishes someone would have thought to screen women.
I have a aneurysm of the distal abdominal aorta with partial calcification with maximum diameter of approximately 4.0 cm. This tapers at the bifurcation. I am a 65 yr old women and I have been reading that the outcomes aren’t as good for womwen then for men. I also have protein in my urine, could that be caused from this aneurysm leaking? What should I expect next, would they want to do an operation on this? Should I not be doing certain things, what things should I be doing? Please advise
I think the most important thing in this setting is to be evaluated by a specialist such as a vascular surgeon or a vascular medicine specialist who can determine the need for intervention, medical treatment and follow-up.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
I was diagnosed with an AAA 2019 during a procedure in a hospital. Since then, my provider who just retired never once said anything about it or any concern & I just forgot about it until my doctor appointment yesterday, 8/7/23, when leaving the clinic was handed a “Patient Care Summary” that listed on one of the pages , Abdominal Aortic Ectasia , Active.
The last 4 days in a row I’ve had excruciating sharp shooting pains in my stomach & it’s not the same as the intense cramping I get from IBS. The only way I’ve been able to cope is by taking a 10 mg, Vicodin. I can tell when the pain medication is wearing off because the pain in my stomach immediately doubles me over. I told my new FNP at my appointment about it yesterday & she dismissed it like it was IBS. I’m a little nervous after reading that I should be followed up closely every 6 months & the doctor should find out how big or small it is . What is your opinion??
I was diagnosed with an AAA 2019 during a procedure in a hospital. Since then, my provider who just retired never once said anything about it or any concern & I just forgot about it until my doctor appointment yesterday, 8/7/23, when leaving the clinic was handed a “Patient Care Summary” that listed on one of the pages , Abdominal Aortic Ectasia , Active.
The last 4 days in a row I’ve had excruciating sharp shooting pains in my stomach & it’s not the same as the intense cramping I get from IBS. The only way I’ve been able to cope is by taking a 10 mg, Vicodin. I can tell when the pain medication is wearing off because the pain in my stomach immediately doubles me over. I told my new FNP at my appointment about it yesterday & she dismissed it like it was IBS. I’m a little nervous after reading that I should be followed up closely every 6 months & the doctor should find out how big or small it is . What is your opinion?? NO I have never posted any comment on this site!
I had a AAA at the age of 36- approximately 5cm- but they never gave me an explanation for what caused it. They placed a stent the next day, and I’ve been monitored for 13 years now
My dad had two aortic aneurysms. He was a smoker and obese. I don’t smoke but I am on BP meds and exposed to my husbands second hand smoke. I am currently losing weight on a fasting diet. How much at risk am I at 63 of developing an AAA?