J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 12, Number 12, December 2020, pages 794-802

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

Figure 2. Age specific distribution of male and female patients admitted with abdominal aortic aneurysm (AAA). It was noted that 65.8% of the male patients admitted with AAA rupture were under 85 years of age and 65.7% of the female patients admitted for AAA rupture were more than 85 years old.

Figure 3. Long-term (over 2 years) survival of the patients discharged alive after AAA repair. X axis represents the months of survival after an emergent abdominal aortic aneurysm (AAA) repair. Y axis is the survival of the patients on a scale of 1 to 0. Males survived an average of 11.0 months (SD = 2.2 months) as compared to 9.3 months in the females (SD = 2.9 months, P = 0.41). The total sample available for the analysis was 27 patients, 21 males and six females.

**Table 1.** Demographic Characteristics of the Male and Female Patients Admitted With Abdominal Aortic Aneurysm (AAA) Rupture
Characteristic	Males (n = 79)	Females (n = 38)	P value
^aMajor comorbidities are defined as diabetes mellitus, cardiovascular diseases including coronary artery, cerebrovascular and carotid artery diseases. ^bAge was adjusted for BMI, smoking history, hypertension, comorbidities, use of aspirin, statin, clopidogrel, beta-blockers, previous history of aneurysm, size and location of aneurysm. BMI: body mass index; SD: standard deviation.
Site, n (%)
Facility 1	52 (65.8)	20 (52.6)
Facility 2	27 (34.2)	18 (47.4)	0.17
Race, n (%)
Caucasian	79 (100)	38 (100)
Others	0	0	N/A
BMI, n (%)			0.02
Normal (< 25.0)	15 (25.8)	11 (58.0)
Overweight (25.1 - 30)	24 (41.3)	6 (31.5)
Obese (> 30.0)	19 (32.9)	2 (10.5)
Smoking, n (%)	66 (83.5)	26 (68.4)	0.06
Hypertension, n (%)	66 (83.5)	33 (86.8)	0.64
Major comorbidities, n (%)^a	38 (48.1)	20 (52.6)	0.64
Aspirin, n (%)	40 (50.6)	18 (47.4)	0.10
Statin, n (%)	40 (50.6)	18 (47.4)	0.74
Clopidogrel, n (%)	7 (8.9)	5 (13.1)	0.47
Beta-blocker, n (%)	24 (30.4)	14 (36.8)	0.48
Age at rupture, mean (SD)^b	75.8 (10.0)	82.4 (8.6)	0.005

Table 1. Demographic Characteristics of the Male and Female Patients Admitted With Abdominal Aortic Aneurysm (AAA) Rupture

Characteristic

Males (n = 79)

Females (n = 38)

P value

^aMajor comorbidities are defined as diabetes mellitus, cardiovascular diseases including coronary artery, cerebrovascular and carotid artery diseases. ^bAge was adjusted for BMI, smoking history, hypertension, comorbidities, use of aspirin, statin, clopidogrel, beta-blockers, previous history of aneurysm, size and location of aneurysm. BMI: body mass index; SD: standard deviation.

Site, n (%)

Facility 1

52 (65.8)

20 (52.6)

Facility 2

27 (34.2)

18 (47.4)

0.17

Race, n (%)

Caucasian

79 (100)

38 (100)

Others

N/A

BMI, n (%)

0.02

Normal (< 25.0)

15 (25.8)

11 (58.0)

Overweight (25.1 - 30)

24 (41.3)

6 (31.5)

Obese (> 30.0)

19 (32.9)

2 (10.5)

Smoking, n (%)

66 (83.5)

26 (68.4)

0.06

Hypertension, n (%)

66 (83.5)

33 (86.8)

0.64

Major comorbidities, n (%)^a

38 (48.1)

20 (52.6)

0.64

Aspirin, n (%)

40 (50.6)

18 (47.4)

0.10

Statin, n (%)

40 (50.6)

18 (47.4)

0.74

Clopidogrel, n (%)

7 (8.9)

5 (13.1)

0.47

Beta-blocker, n (%)

24 (30.4)

14 (36.8)

0.48

Age at rupture, mean (SD)^b

75.8 (10.0)

82.4 (8.6)

0.005

**Table 2.** Characteristics of the Ruptured Abdominal Aortic Aneurysms (AAA) in the Male and Female Patients at Presentation, Based on the CT Scan Findings
Characteristic	Males (n = 79)	Females (n = 38)	P value
CT: computerized tomography; SD: standard deviation.
Location of the aneurysm, n (%)			0.28
Infrarenal	75 (94.9)	34 (89.5)
Suprarenal	0 (0)	1 (2.6)
Both	4 (5.1)	3 (7.9)
Involvement of iliac arteries, n (%)			0.42
Left	6 (7.6)	1 (2.6)
Right	9 (11.4)	4 (10.5)
Both	12 (15.2)	3 (7.9)
None	52 (65.8)	30 (78.9)
Size of aneurysm at rupture (cm), mean (SD)	8.23 (1.84)	7.46 (2.09)	0.04
Known history of AAA repair, n (%)	46 (58.2)	19 (50)	0.34
Previous surgical history of AAA repair, n (%)	23 (29.1)	4 (10.5)	0.04
AAA size at earlier diagnosis, (cm), mean (SD)	4.0 (3.3)	5.0 (2.6)	0.03

Table 2. Characteristics of the Ruptured Abdominal Aortic Aneurysms (AAA) in the Male and Female Patients at Presentation, Based on the CT Scan Findings

Characteristic

Males (n = 79)

Females (n = 38)

P value

CT: computerized tomography; SD: standard deviation.

Location of the aneurysm, n (%)

0.28

Infrarenal

75 (94.9)

34 (89.5)

Suprarenal

0 (0)

1 (2.6)

Both

4 (5.1)

3 (7.9)

Involvement of iliac arteries, n (%)

0.42

Left

6 (7.6)

1 (2.6)

Right

9 (11.4)

4 (10.5)

Both

12 (15.2)

3 (7.9)

None

52 (65.8)

30 (78.9)

Size of aneurysm at rupture (cm), mean (SD)

8.23 (1.84)

7.46 (2.09)

0.04

Known history of AAA repair, n (%)

46 (58.2)

19 (50)

0.34

Previous surgical history of AAA repair, n (%)

23 (29.1)

4 (10.5)

0.04

AAA size at earlier diagnosis, (cm), mean (SD)

4.0 (3.3)

5.0 (2.6)

0.03

**Table 3.** Characteristics Describing the Hospital Course and Mortality of the Ruptured Abdominal Aortic Aneurysms in the Male and Female Patients
Characteristic	Males (n = 79)	Females (n = 38)	P value^c
^aAdjusted for tobacco use, age, size at presentation, major comorbidities and use of cardio-protective medications. ^bThe incidence of surgery was adjusted for age, major comorbidities and size at presentation. ^cThe overall mortality was still at a statistically significant level of less than 0.05 even for the unadjusted sample. However, the postoperative mortality for the unadjusted sample was 0.26 as compared to 0.05 for the adjusted sample.
Overall mortality, n (%)^a	25 (31.6)	26 (68.4)	0.001
Operative course
Surgical management, n (%)^b	74 (93.7)	24 (63.2)	0.03
Type of surgery^b
EVAR, n (%)	57 (72.2%)	16 (42.1%)	< 0.01
Open, n (%)	17 (21.5%)	8 (21.1%)
None, n (%)	5 (6.3%)	14 (36.8%)
Postoperative course^a	Males (n = 74)	Females (n = 24)
Ventilator requirement, n (%)	44 (59.5)	18 (75)	0.17
Requirement of vasopressors, n (%)	40 (54.1)	17 (70.8)	0.15
Unexpected postoperative complications, n (%)	38 (48.6)	10 (58.3)	0.41
Length of stay in intensive care unit, days (SD)	4.1 (4.1)	5.5 (6.0)	0.02
Postoperative mortality, n (%)^a	21 (21.4)	12 (50.0)	0.05

Table 3. Characteristics Describing the Hospital Course and Mortality of the Ruptured Abdominal Aortic Aneurysms in the Male and Female Patients

Characteristic

Males (n = 79)

Females (n = 38)

P value^c

^aAdjusted for tobacco use, age, size at presentation, major comorbidities and use of cardio-protective medications. ^bThe incidence of surgery was adjusted for age, major comorbidities and size at presentation. ^cThe overall mortality was still at a statistically significant level of less than 0.05 even for the unadjusted sample. However, the postoperative mortality for the unadjusted sample was 0.26 as compared to 0.05 for the adjusted sample.

Overall mortality, n (%)^a

25 (31.6)

26 (68.4)

0.001

Operative course

Surgical management, n (%)^b

74 (93.7)

24 (63.2)

0.03

Type of surgery^b

EVAR, n (%)

57 (72.2%)

16 (42.1%)

< 0.01

Open, n (%)

17 (21.5%)

8 (21.1%)

None, n (%)

5 (6.3%)

14 (36.8%)

Postoperative course^a

Males (n = 74)

Females (n = 24)

Ventilator requirement, n (%)

44 (59.5)

18 (75)

0.17

Requirement of vasopressors, n (%)

40 (54.1)

17 (70.8)

0.15

Unexpected postoperative complications, n (%)

38 (48.6)

10 (58.3)

0.41

Length of stay in intensive care unit, days (SD)

4.1 (4.1)

5.5 (6.0)

0.02

Postoperative mortality, n (%)^a

21 (21.4)

12 (50.0)

0.05