Introduction :
Abdominal aortic aneurysms (AAA) affect males to females at the ratio of
4:1 but females are known to have worse outcomes.1Available literature suggests that ruptured aneurysms occur in females
more frequently and also at smaller diameters compared to
males.1 The prevalence of AAAs with diameter larger
than 2.9 cm in males ranges from 1.9 to 18.5% which is much higher than
females (0 to 4.2%).2 Females with AAAs usually
present late, grow rapidly than males, and also have a four-time higher
risk of rupture at a diameter 5.0-5.9 cm than males.3The average annual risk of rupture of AAA with ≥ 6 cm is 14.1% in males
and 22.3% in females. The mortality of AAA rupture is about
50%.4
In 2017, total deaths due to AAA were about 9928 which was up from 2600
in 2013.5,6 Surgical intervention either by
endo-vascular repair (EVAR) or open repair is offered for aneurysms
≥5.5cm in both males and females. Rupture of AAA is a medical emergency
and is associated with a very high pre-hospitalization
mortality.7 Some reports also suggest that females who
received EVAR or open repair were more likely to have a higher
postoperative mortality than males. Differences in diagnosis and
treatment rates or inherent anatomical dissimilarities and lack of
screening for females seem to be the reasons for higher mortality rate
in females.5
Ultrasound has 90% sensitivity and 100% specificity to diagnose AAA
and has been the standard screening tool for AAA. The 2019 United States
Preventive Services Task Force (USPSTF) guidelines recommend one-time
screening with ultrasonography in males aged 65-75 years who had ever
smoked. When it comes to screening guidelines in females, USPSTF
concludes that there is insufficient evidence to screen females aged
65-75 years who had ever smoked.8 These
recommendations have been consistent for many years even after multiple
studies suggesting higher mortality in females as illustrated above.
With this study, we attempted to specifically study the characters of
ruptured AAAs in an attempt to study the outcomes in females as compared
to males.