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.