Aortic aneurysm: male/female differences finally taken into account

An aneurysm is defined as an increase in the size (diameter) of an artery of more than 50% compared with the normal value: if the normal value is 20 mm, the anomaly starts at 30 mm.
Aneurysms can be located in any artery, with particular attention paid to the aorta (the largest artery) in the abdomen.
The main risk with these aneurysms is rupture, which can have very serious consequences, with one in two deaths. As in the vast majority of cases there are no symptoms, they should be systematically detected by ultrasound of the abdomen if risk factors are present from the age of 60 to 65. The most important risk factor is smoking, often associated with a family history. Over time, it will steadily increase in size, especially in hypertensive patients, with a greater risk of rupture.
Above a certain size, the treatment consists of an operation that should be carried out before the occurrence of the sudden accident.

Epidemiological data:
[1, 2, 3]

Aneurysms are 3 times more frequent in men.
But the rate of growth (increase in size) is 80 times faster in women.
The risk of rupture is 4 times higher in women than in men.
Women are 80% less likely to undergo surgery for an uncomplicated aneurysm, and 40% less likely to have a ruptured aneurysm.
Mortality before hospitalization and during surgery is 86% in women, 79% in men
Recent recommendations:

The European Society of Vascular Surgery (ESVS) has just published recommendations [4] in which, for the first time, a clear difference is made between men and women for all elements.
Previously, surgery was indicated for a size of 50 or 55 mm regardless of gender, and the frequency of surveillance of a known abnormality or after surgery was identical.
With these recommendations, men should be operated on for values of 55 mm, but women from 50 mm upwards. The simple explanation is that women usually have smaller arteries, and so the same figure corresponds to a larger anomaly.
Similarly, ultrasound monitoring is different for large anomalies: every 6 months if the diameter is 50 mm in men, 45 in women.
Finally, medical management consists of the now classic management of risk factors, since these patients are rightly considered to be at high cardiovascular risk, with a high risk of myocardial infarction and stroke. The annual death rate from cardiovascular causes is 3%.
It's essential to stop smoking, keep blood pressure and cholesterol under control, and take aspirin (a new feature) in addition to the usual lifestyle measures: diet and physical activity.

Conclusion:

Are we moving towards medicine by gender? That's what we'd like to see, given the many differences between the sexes, with, as we know, women receiving less care.
It's gratifying that vascular pathology is setting the example and leading the way.

References:
[1] Brown P.M et al : J. Vasc Surg 2003
[2] Vanhaidinen A et al : J Vasc Surg 2006
[3] Modfi B et al ; Br J Surg 2007
[4] Vanhaidinen A et al : Eur Vasc Endovasc Surg 2024

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