Gender-Based Differences in Abdominal Aortic Aneurysm Rupture: A Retrospective Study

Srikrishna Varun Malayala, Ambreen Raza, Rachana Vanaparthy


Background: Annually, 5% of sudden deaths are due to abdominal aortic aneurysm (AAA) rupture. There is evidence suggesting that AAA ruptures have worse outcomes in females than males and the aneurysms rupture at a smaller size in females than in males. The United States Preventive Services Task Force (USPSTF) recommends a one-time ultrasound screening for males aged 65 - 75 years who ever smoked. There is insufficient evidence to screen females aged 65 - 75 years who ever smoked though there is evidence suggesting that AAAs rupture at a smaller size and have worse outcomes in females. The objective of this study is to compare the characteristics, mortality and morbidity of ruptured AAAs in females and males.

Methods: This is a retrospective review of 117 patients from two teaching institutions over a period of 6 years. A total of 39 parameters were compared between males and females including demographic variables, comorbidities like hypertension, dyslipidemia, cardiovascular diseases; previous history of AAA; medications, characteristics of aneurysm, type of surgery and its outcome; postoperative complications and long-term survival.

Results: The overall incidence of AAA rupture was higher in males (68%) than in females (32%). Females die from AAA rupture at a later age. There was a significant difference in the size of AAA rupture between females (mean = 7.4 cm, standard deviation (SD) = 2.0) and males (mean = 8.2 cm, SD = 1.8; P = 0.04). The probability to undergo surgery for ruptured AAA was significantly lower for females as compared to males (P = 0.03). Females had higher overall mortality (P = 0.001), postoperative mortality (P = 0.02), higher length of intensive care unit (ICU) stay, incidence of postoperative complications, use of vasopressors and use of ventilator.

Conclusions: Using a similar threshold of size of AAA for elective surgery for both males and females might not be appropriate. Further population-based studies are needed to warrant AAA screening for high-risk females owing to the higher morbidity and mortality.

J Clin Med Res. 2020;12(12):794-802

Correction in J Clin Med Res. 2021;13(7):412, doi:


Aneurysm; Females; Mortality; AAA; Rupture; Ultrasound; Screening

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