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circulatory

Abdominal aortic aneurysm ruptures are more common in women than men
Abdominal aortic aneurysm ruptures are more common in women than men Each year more than 200,000 Americans get an abdominal aortic aneurysm (AAA) and 15,000 (75 to 90 percent) die from one. More men than women comprise the five to seven percent of adults who are sixty years of age or older who have an AAA; however two to three percent of women who have an AAA have four times the risk of rupture. The abdominal aorta (the largest artery in the abdomen) supplies blood to the lower part of the body. In the abdomen, just below the navel, the aorta splits into two branches, called the iliac arteries, which carry blood into each leg. As blood flows through the abdominal aorta, it can push and expand the artery wall causing it to weaken, enlarge, and bulge out, creating an AAA.

If an AAA is found to be nearing five centimeters or larger, the chance of rupture becomes significant; and a vascular surgeon can repair it by open incision or a minimally invasive procedure called an endovascular aneurysm repair (EVAR). Often women get aneurysmal disease later in life due to hormonal and other factors. Females experience more smaller aneurysms and worse outcomes than their male counterparts do.

Women are less likely to be offered EVAR to correct an AAA, mainly because they have smaller arteries and the current endovascular devices are made to fit the male anatomy. Females are more likely than males to die following open surgery; but when given the option of EVAR women have a death rate almost as low as men and respond by displaying a more rapid shrinkage of their aneurysm.

Patients may describe a pulsing feeling or pain in their abdomen that physicians can sometimes feel, or a sudden pain in the lower back, but most of the time aneurysms have no symptoms. Any sudden abdomen or back pain could be a sign of rupture and would require immediate medical attention.

Age, heart disease, and smoking are major risk factors that increase the chance of AAA; and if a woman has all three, her risk of AAA rupture can be as high as seven percent. Other risks are hypertension, high cholesterol, obstructive pulmonary disease, and family history. Immediate relatives are at increased risk; and if people have a sibling with an AAA, their risk increases five-fold.

The normal size of an AAA is two centimeters. If larger, a screening can be monitored by a vascular surgeon every six months to a year by CT scan, ultrasound, magnetic resonance imaging (MRI), or sonogram. Blood pressure medication may be prescribed to lower the pressure on the weakened area of the aneurysm.

The U.S. Preventive Service Task Force currently does not recommend screening for AAA in women. According to some researchers this may be misguided, because AAA is somewhat less common in women and at the same time there are women with risk factors who deserve screening.

The Society for Vascular Surgery recommends abdominal ultrasound AAA screening for all men ages 60 to 85 years or people ages 50 and older with a history of AAA, as well as all women ages 60 to 85 years with cardiovascular risk factors.



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"Abdominal aortic aneurysm ruptures are more common in women than men"
   authored by:
VASCULAR
Eva Rzucidlo, MD, is a vascular surgeon at Dartmouth-Hitchcock Medical Center in Lebanon, NH, and chair of the Women’s Leadership Committee at the Society for Vascular Surgery.

The Society for Vascular Surgery® (SVS) is a not-for-profit pr...



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