Gender differences in abdominal aortic aneurysm therapy – a                     systematic review

Abstract. This article analyses if and to what extent gender differences exist in abdominal aortic aneurysm (AAA) therapy. For this purpose Medline (PubMed) was searched from January 1999 to January 2018. Keywords were: “abdominal aortic aneurysm”, “gender”, “prevalence”, “EVAR”, and “open surgery of abdominal aortic aneurysm”. Regardless of open or endovascular treatment of abdominal aortic aneurysms, women have a higher rate of complications and longer hospitalizations compared to men. The majority of studies showed that women have a lower survival rate for surgical and endovascular treatment of abdominal aneurysms after both elective and emergency interventions. Women receive less surgical/interventional and protective medical treatment. Women seem to have a higher risk of rupture, a lower survival rate in AAA, and a higher rate of complications, regardless of endovascular or open treatment. The gender differences may be due to a higher age of women at diagnosis and therapy associated with higher comorbidity, but also because of genetic, hormonal, anatomical, biological, and socio-cultural differences. Strategies for treatment in female patients must be further defined to optimize outcome.

Download Full-text

Current evidence and prospects for medical treatment of abdominal aortic aneurysms

VASA ◽

10.1024/0301-1526.34.4.217 ◽

2005 ◽

Vol 34 (4) ◽

pp. 217-223 ◽

Cited By ~ 11

Author(s):

Diehm ◽

Schmidli ◽

Dai-Do ◽

Baumgartner

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Medical Treatment ◽

Endovascular Treatment ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Current Evidence ◽

Significant Morbidity ◽

Abdominal Aortic ◽

Risk Of Rupture

Abdominal aortic aneurysm (AAA) is a potentially fatal condition with risk of rupture increasing as maximum AAA diameter increases. It is agreed upon that open surgical or endovascular treatment is indicated if maximum AAA diameter exceeds 5 to 5.5cm. Continuing aneurysmal degeneration of aortoiliac arteries accounts for significant morbidity, especially in patients undergoing endovascular AAA repair. Purpose of this review is to give an overview of the current evidence of medical treatment of AAA and describe prospects of potential pharmacological approaches towards prevention of aneurysmal degeneration of small AAAs and to highlight possible adjunctive medical treatment approaches after open surgical or endovascular AAA therapy.

Download Full-text

Short-term (30-day) Outcome of Endovascular Treatment of Abdominal Aortic Aneurysm: Results from the Prospective Registry of Endovascular Treatment of Abdominal Aortic Aneurysms (RETA)

European Journal of Vascular and Endovascular Surgery ◽

10.1053/ejvs.2000.1268 ◽

2001 ◽

Vol 21 (1) ◽

pp. 57-64 ◽

Cited By ~ 53

Author(s):

S.M Thomas ◽

P.A Gaines ◽

J.D Beard

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Treatment ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Short Term ◽

Abdominal Aortic

Download Full-text

Endovascular Treatment of Aortic Aneurysms in Finland: The First Four Years' Experience

Scandinavian Journal of Surgery ◽

10.1177/145749690209100204 ◽

2002 ◽

Vol 91 (2) ◽

pp. 155-159 ◽

Cited By ~ 5

Author(s):

P. S. Aho ◽

G. Pimenoff ◽

J. P. Salenius ◽

S. Leinonen ◽

K. Ylönen ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Treatment ◽

Aortic Aneurysms ◽

Interventional Radiologist ◽

Secondary Interventions ◽

Abdominal Aortic ◽

Short Time ◽

Mid Term Results

Background and aims: In this study the results of endovascular treatment of aortic aneurysms in Finland are presented and compared to the results of the Eurostar registry. Material and methods: A total of 229 patients with aortic aneurysm were treated in five different Finnish centres during 1996–2000. The data of these patients were collected prospectively by surgeon or interventional radiologist involved. During the same period of time 2464 patients were registered in the Eurostar registry. Results: The procedure was performed successfully in 97 % of patients in Finland, and the 30-day mortality was 0,9 %. A graft limb thrombosis was detected in 9 % of the patients in Finland. A permanent primary endoleak at the first 30-day control was seen in 23 patients (10 %). During the follow-up 17 secondary endoleaks (7 %) were detected. A secondary intervention was necessary in 26 % of the patients. Three patients (1.3 %) had late rupture of the abdominal aortic aneurysm. Conclusions: According to the Finnish short-time results, endovascular treatment of aortic aneurysms is safe and associated with relatively low morbidity and mortality. The mid-term results are more disappointing with relatively many graft thromboses and endoleaks, and a frequent need of secondary interventions.

Download Full-text

Vascular Deformation Mapping of Abdominal Aortic Aneurysm

Tomography ◽

10.3390/tomography7020017 ◽

2021 ◽

Vol 7 (2) ◽

pp. 189-201

Author(s):

Drew J. Braet ◽

Jonathan Eliason ◽

Yunus Ahmed ◽

Pieter A. J. van Bakel ◽

Jiayang Zhong ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Complex Disease ◽

Endovascular Aneurysm Repair ◽

Three Dimensional ◽

Aortic Aneurysms ◽

Maximum Diameter ◽

Abdominal Aortic ◽

Risk Of Rupture ◽

Imaging Surveillance

Abdominal aortic aneurysm (AAA) is a complex disease that requires regular imaging surveillance to monitor for aneurysm stability. Current imaging surveillance techniques use maximum diameter, often assessed by computed tomography angiography (CTA), to assess risk of rupture and determine candidacy for operative repair. However, maximum diameter measurements can be variable, do not reliably predict rupture risk and future AAA growth, and may be an oversimplification of complex AAA anatomy. Vascular deformation mapping (VDM) is a recently described technique that uses deformable image registration to quantify three-dimensional changes in aortic wall geometry, which has been previously used to quantify three-dimensional (3D) growth in thoracic aortic aneurysms, but the feasibility of the VDM technique for measuring 3D growth in AAA has not yet been studied. Seven patients with infra-renal AAAs were identified and VDM was used to identify three-dimensional maps of AAA growth. In the present study, we demonstrate that VDM is able to successfully identify and quantify 3D growth (and the lack thereof) in AAAs that is not apparent from maximum diameter. Furthermore, VDM can be used to quantify growth of the excluded aneurysm sac after endovascular aneurysm repair (EVAR). VDM may be a useful adjunct for surgical planning and appears to be a sensitive modality for detecting regional growth of AAAs.

Download Full-text

Endovascular Treatment of Abdominal Aortic Aneurysms: Lessons Learned

Journal of Endovascular Therapy ◽

10.1177/152660289700400202 ◽

1997 ◽

Vol 4 (2) ◽

pp. 102-110 ◽

Cited By ~ 15

Author(s):

Juan Carlos Parodi ◽

Andrea Barone ◽

Ruben Piraino ◽

Claudio Schonholz

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Treatment ◽

Clinical Evaluation ◽

Preoperative Assessment ◽

Abdominal Aortic Aneurysms ◽

Lessons Learned ◽

Aortic Aneurysms ◽

Abdominal Aortic ◽

Implantation Techniques

The authors offer an overview of their 20-year involvement in the development of an endovascular graft for abdominal aortic aneurysm exclusion. Clinical experience gained throughout 6 years of clinical evaluation are reviewed, along with observations and insights on preoperative assessment, implantation techniques, and complications.

Download Full-text

Comparison of open versus endovascular surgical treatment of abdominal aortic aneurysm

Current Directions in Biomedical Engineering ◽

10.1515/cdbme-2020-3123 ◽

2020 ◽

Vol 6 (3) ◽

pp. 477-480

Author(s):

Sabine Kischkel ◽

Carsten M. Bünger

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Treatment Options ◽

Prosthetic Graft ◽

Healthcare Research ◽

Vascular Medicine ◽

Related Complication ◽

Abdominal Aortic ◽

Open Aortic Repair ◽

Risk Of Rupture

AbstractAbdominal aortic aneurysm (AAA) is a common condition of increasing prevalence, particularly among older men. An AAA is defined as a permanent dilation of the abdominal aorta, with a diameter greater than 30 mm or a diameter greater than 50% of the aortic diameter at the level of the diaphragm. As the size of the aneurysm increases, so does the risk of rupture. Therefore, prophylactic repair with insertion of a prosthetic graft is offered. Since 1951 traditional open aneurysm repair (OAR) was reported and minimally invasive endovascular repair (EVAR) was first reported in 1986. Data from four randomized controlled trials (EVAR-1, DREAM, OVER, ACE) for abdominal aortic aneurysm, which enrolled almost 3000 patients, in a period from 1999 to 2008, were summarized. In addition, registry databases on the treatment of AAA of average 4000 patients per year, based from 2015 to 2018 of the German Institute for Vascular Medicine Healthcare Research of the German Society for Vascular Surgery and Vascular Medicine, were compared. The EVAR procedure for AAA showed a lower risk of perioperative mortality but was associated with a higher cardiovascular and aneurysm-related complication rate. In particular, patients aged 80 years or older benefited from EVAR since the 30-day mortality of patients receiving OAR was higher. In mid-term and long-term follow-up there were no differences in survival after endovascular and open aortic repair. Overall, it depends on the respective underlying disease and anatomy which of the two approaches is to be preferred. In conclusion, both treatment options can be considered as equal and can be offered to patients.

Download Full-text

A 60-year-old woman with asymptomatic total thoracic–abdominal aortic aneurysm

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01600-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Jianying Deng ◽

Wei Liu

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Effective Treatment ◽

Clinical Symptoms ◽

Aortic Aneurysms ◽

Case Presentation ◽

Second Stage ◽

Aortic Replacement ◽

Abdominal Aortic ◽

Thoracoabdominal Aortic Replacement

Abstract Introduction Total thoracic–abdominal aortic aneurysm is a rare disease in cardiovascular surgery, with high surgical risk and high mortality. Surgery is considered the most effective treatment for total aortic aneurysms. Case presentation Our group admitted a 60-year-old female patients with asymptomatic complex total thoracic–abdominal aortic aneurysm, and successfully performed two-staged surgery, namely Bentall + Sun’s operation in the first-stage and thoracoabdominal aortic replacement in the second-stage. The results of the surgery were satisfactory. Conclusions Patients with total thoracic–abdominal aortic aneurysm may not have typical clinical symptoms and require a careful and comprehensive physical examination and related auxiliary examinations by clinicians. Staged repair of total thoracic–abdominal aortic aneurysms is still a safe and effective treatment.

Download Full-text