Available online 10 October 2023

Thoracic and thoracoabdominal aortic aneurysms are more common in men. Yet, women often have worse outcomes, fewer interventions, and lower treatment rates. Women have also benefited less than men in the research and treatment of those diseases. Understanding sex and gender-specific differences in thoracic and thoracoabdominal aortic aneurysms can improve care delivery, reduce disparities, and optimize outcomes for women with thoracic aortic aneurysms and thoracoabdominal aortic aneurysms. In this review, we present the literature on the presentation and outcomes of thoracic and thoracoabdominal aortic aneurysms in women, discussing the existing gaps and future directions to address them.

The differences between men and women who present with aortic disease have been increasingly discussed in the literature in recent years. Differences have been reported regarding screening, presentation, disease progression, intervention, and outcomes, which holds regardless of the anatomical location of the aortic aneurysm. Women present at an older age, later to the hospital, have a faster aortic aneurysm growth rate, a higher risk of dying outside of the hospital, and worst aortic-related

PubMed database was searched from its inception to May 2023 for articles relevant to the objectives of this review, including articles discussing the presentation and outcomes of descending thoracic (DTAA) and thoracoabdominal aortic aneurysms (TAAA) in women. We searched using the keywords: thoracic aortic aneurysm; thoracoabdominal aortic aneurysm; sex; gender; women; endovascular repair; and aortic repair. We excluded editorials and review articles. In all, 14 articles discussing DTAA and 16

Sex-specific guidelines for the management of aneurysms are lacking. The U.S. Preventive Services Task Force does not recommend abdominal aortic aneurysm (AAA) screening for women.48 Since women present at a more advanced stage of disease, as evidenced by their older age at diagnosis, higher frailty metrics, more extensive aneurysms, and greater aortic size index, widespread screening for women by primary care physicians and vascular surgeons using the SVS-expanded screening guidelines should

The biggest limitation of our review is the heterogeneity of the studies. First, what cohorts are included in the study, as many combine DTAA and TAAA. Second, is the definition of early mortality. Some define it as in-hospital mortality while others as 30-day mortality. Third, is the difference in definitions of sex vs. gender. They are often used interchangeably, even though they differ. “Sex” refers to biological, chromosomal, and anatomical features associated with the male and female body.

In this review, we demonstrated plenty of literature supporting the notion of existing sex- and gender-specific disparities in thoracic and thoracoabdominal aortic disease. To bridge the gaps and improve those disparities, future trials and studies should be designed with sex- and gender-specific considerations in mind, including well-thought-out plans for increasing the participation of women in those trials. We need better data to update the existing guidelines for sex-specific guidelines.

Chung J, Coutinho T, Chu MWA, Ouzounian M. Sex differences in thoracic aortic disease: A review of the literature and a call to action. J Thorac Cardiovasc Surg. 2020 Sep;160(3):656-660.

Erben Y, Bews KA, Hanson KT, Rocha-Franco JA, Money SR, Stone W, et al. Female Sex is a Marker for Higher Morbidity and Mortality after Elective Endovascular Aortic Aneurysm Repair: A National Surgical Quality Improvement Program Analysis. Ann Vasc Surg. 2020 Nov;69:1-8.

Shalhub S, Wallace S, Okunbor O, Newhall

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:

Dr. Afifi is a consultant for Medtronic and EndoRon Ltd. The other authors have no relevant conflicts of interest.

© 2023 Published by Elsevier Inc.