Should abdominal aortic aneurysm be managed differently in women?

Although abdominal aortic aneurysm (AAA) is 4 to 6 times more common in men than in women, more than a third of all AAA deaths occur in women. In several reports from the UK Small Aneurysm Trial group, the rupture rate for women was 3-4 times that seen in men. A joint council of several vascular societies responded to these observations with the recommendation that AAA should be repaired earlier in women, at 4.5 cm to 5.0 cm rather than the 5.5 cm established in randomized trials for men. However, this recommendation does not appear to reflect a full consideration of the evidence. For example, population-based studies have reported mortality following AAA repair to be 40-60% higher in women than in men. Also, in the UK Small Aneurysm Trial itself, there was no trend toward a benefit from early repair in women. The totality of evidence available at present provides no good reason to alter for women the 5.5 cm threshold for elective repair established for men by the small AAA trials.