Women with large intact abdominal aortic aneurysms remain untreated

Mareia Talvitie; Linn Åldstedt-Nyrønning; Malin Stenman; Joy Roy; Tina Cohnert; Rebecka Hultgren

doi:10.1016/j.jvs.2023.05.025

Women with large intact abdominal aortic aneurysms remain untreated

J Vasc Surg. 2023 Sep;78(3):657-667.e5. doi: 10.1016/j.jvs.2023.05.025. Epub 2023 May 20.

Authors

Mareia Talvitie¹, Linn Åldstedt-Nyrønning², Malin Stenman³, Joy Roy⁴, Tina Cohnert⁵, Rebecka Hultgren⁴

Affiliations

¹ Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden. Electronic address: mareia.talvitie@regionstockholm.se.
² Department of Surgery, Vascular Surgery, St Olavs Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway.
³ Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden.
⁴ Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
⁵ Department of Vascular Surgery, Medical University of Graz, Graz, Austria.

PMID: 37211143
DOI: 10.1016/j.jvs.2023.05.025

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).

Keywords: Abdominal; Aortic aneurysm; Aortic rupture; Conservative treatment; Eligibility Determination; Mortality; Women.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aortic Aneurysm, Abdominal* / diagnostic imaging
Aortic Aneurysm, Abdominal* / epidemiology
Aortic Aneurysm, Abdominal* / surgery
Aortic Rupture* / surgery
Blood Vessel Prosthesis Implantation*
Cohort Studies
Endovascular Procedures* / adverse effects
Female
Humans
Male
Retrospective Studies
Risk Factors
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT05346289