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Gender Specific Variations In Abdominal Aortic Aneurysm Treatment Approaches
Huong Truong, MD, Talia Morchower.
Robert Wood Johnson Rutgers, New Brunswick, NJ, USA.
Objective: The diameter of an abdominal aortic aneurysm (AAA) is a common criterion for surgical intervention, but guidelines for females are less clear than for males. The Society for Vascular Surgery (SVS) suggests repair at >5.0cm for females and >5.5cm for males; however, sub-diameter repairs are common due to factors like morphology, anatomy, and symptoms. The aortic size index (ASI), which considers aortic diameter relative to body surface area, has been proposed as a potentially better indicator for AAA repair in females. This study aimed to analyze the factors influencing sub-diameter repair of AAA in females, including morphology, symptoms, and rupture.
Methods: Data from patients aged 18-90 undergoing AAA repair between 2011-2020 at a single institution were analyzed. Chi-square tests using R-statistical software were employed to compare co-morbidities, treatment indications, aneurysm size at treatment, and aneurysm morphology between males and females.
Results: Out of 353 patients, 175 (49.57%) underwent treatment based on aneurysm size, and 171 (48.44%) were treated for symptoms. The remaining patients were treated for ruptured AAA. When comparing treatment indications, males were more likely to undergo treatment for symptoms (41.5%) compared to females (31.3%), with a p-value of 0.0028. Furthermore, females were more frequently treated according to Society for Vascular Surgery size guidelines (59.4%) than males (41.4%), with a p-value of 0.0033.
Conclusion: Analysis of AAA repair cases between 2011-2020 revealed significant gender-based differences in treatment indications. Males more often underwent repair for symptomatic AAA, while females were more frequently treated according to size guidelines. These findings underscore the need for gender-specific considerations in AAA management, particularly concerning the threshold for surgical intervention based on symptoms versus size. Further exploration of aneurysm morphology and aortic size index may offer insights to optimize treatment strategies for both male and female patients in the future.
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