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Gender Differences with Aortic Aneurysm

Our body’s largest blood vessel, the aorta carries blood from the heart to all ofcouple our vital organs. When a bulge or weak area – also called an aneurysm – develops, careful consideration must be given to its size and location. Physicians must also factor in the patient’s gender to ensure that the best course of action is taken.

According to Gilbert R. Upchurch, Jr., MD, Chief of Vascular and Endovascular Surgery at the University of Virginia Health System, four men for every one woman are affected by this condition. However, for women, aneurysms are more likely to be fatal. We spoke to Dr. Upchurch about the occurrence of aneurysms in men and women and why the treatment may vary for the sexes.

What are the two types of aortic aneurysms?

A thoracic aortic aneurysm occurs in the upper part of the aorta that runs through the chest. An abdominal aortic aneurysm occurs in the lower portion of the aorta that reaches into the abdomen. Abdominal aortic aneurysms are much more common than ones in the chest.

Which type is more common among women?

Men are more likely to get abdominal aortic aneurysms, while thoracic aortic aneurysms are more equally spread across men and women. However, women do more poorly when an abdominal aortic aneurysm is present. Their risk of dying from surgery is 1.3-fold higher than that of men.

Why do women fare more poorly when diagnosed with aortic aneurysm?

Many more men are candidates for endovascular surgery, an outpatient procedure to repair the artery by threading a metal-enforced tube (stent) through a blood vessel in the patient’s leg. Women do not always qualify for this less-invasive approach because their arteries are too narrow for the stent or the aneurysm is too close to other vital arteries. Instead, many women must undergo a more risky procedure in which a large incision is made in the abdomen.

What are the symptoms of an aneurysm?

Aortic aneurysms often have no symptoms. However, when they do appear, symptoms are typically the same in men and women. Back pain, abdominal pain or pain between the shoulder blades can be a sign of a faulty aorta but they can also be signs of many other conditions. So an aneurysm may not be the first condition to come to mind, especially in women. If a woman is at risk, she should receive a chest CT scan if a thoracic aneurysm is suspected or an ultrasound scan if the aneurysm is likely to be in the abdomen.

What are the risk factors associated with aortic aneurysms?

Family history of aortic aneurysm, hypertension (high blood pressure) and smoking are all factors that may cause and worsen aortic aneurysms, as well as increase the risk of rupture.

When should aortic aneurysms be treated aggressively?

The course of action depends on the size of the aneurysm and the gender of the patient. If spotted soon enough, the aneurysm may remain under observation and medication may be prescribed. But if the diameter of the aorta reaches 5 to 6 cm, doctors typically recommend repairing the weakened area. Repair may be suggested even sooner for women because of the discrepancy in artery size: a 5 cm aneurysm in a man doubles the aorta’s diameter. But for women, an aneurysm that size triples the aorta’s diameter.

What is the most common outcome if an aneurysm is not treated?

This condition is typically fatal if the aneurysm ruptures.

If an aneurysm is diagnosed, how do you prevent it from getting worse?

Lifestyle modification is the number one thing you can do: stop smoking and lower your blood pressure.

 

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