Though initially protected from vessel dilation by estrogen, women may experience rapid abdominal aortic aneurysm (AAA) growth post-menopause. The rate of growth has been poorly defined in prior literature. Here, we describe aneurysm growth in a cohort of women found through an AAA screening program. Women with AAAs were retrospectively identified. Aortic imaging was reviewed, and measurements of maximum transverse and anterior-posterior diameters were completed. Growth was stratified by the type of aortic pathology (fusiform aneurysm, aortic ectasia, dissection with aneurysmal degeneration, saccular aneurysm) as well as size category (<3 cm, 3.0-3.9 cm, 4.0-4.9 cm, ≥5.0 cm) at diagnosis. A cohort of 488 women was identified; 286 had multiple scans for review. The mean age of the entire cohort was 75 ± 9.9 years. Stratified by type of pathology, the mean age was 76 ± 8.9 years in patients with a fusiform AAA, 74 ± 9.8 years in ectasia, 65 ± 13.7 years in dissection, and 76 ± 5.6 years in saccular aneurysms. The maximum growth was highest in women with fusiform AAAs, followed by dissection, ectasia, and saccular pathology (9.7 mm, 7.0 mm, 3.0 mm, and 2.2 mm, respectively; < .001). Comparing mean growth by year, the highest mean growth was in fusiform AAAs (3.6 mm vs 1.75 mm in dissection; < .001). The Shapiro-Wilk test demonstrated that mean growth per year was non-normally distributed with a right skew. Stratified by aortic diameter at the time of diagnosis, mean growth/year increased with increasing size at diagnosis in fusiform AAAs and dissection (0.91 mm for <3 cm, 2.34 mm for 3.0-3.9 cm, 2.49 mm for 4.0-4.9 mm, and 6.16 mm for ≥5.0 cm in patients with fusiform AAAs vs 0.57 mm, 0.94 mm, 1.87 mm, and 2.66 mm, respectively, for patients with dissection). Smoking history was associated with a higher mean growth/year (2.6 mm vs 3.3 mm; < .001). Conversely, patients with a family history of AAA had a lower mean growth/year (3.2 mm vs 1.5 mm; < .001). The rate of aneurysm growth in women varies based on pathology and aneurysm size, and women experience rapid aneurysm growth at sizes greater than 4.5 cm. Current screening guidelines are inadequate, and our results demonstrate that the rate of growth of fusiform aneurysms in women is faster than in men at a smaller size and may warrant more frequent surveillance than current Society for Vascular Surgery recommendations to prevent risk of increased morbidity.

中文翻译：

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评估女性腹主动脉瘤的生长模式

尽管雌激素最初可以保护女性免受血管扩张的影响，但女性在绝经后可能会经历腹主动脉瘤（AAA）的快速生长。先前的文献中对增长率的定义并不明确。在这里，我们描述了通过 AAA 筛查项目发现的一组女性的动脉瘤生长情况。回顾性鉴定患有 AAA 的女性。审查了主动脉成像，并完成了最大横向直径和前后直径的测量。诊断时根据主动脉病理类型（梭状动脉瘤、主动脉扩张、动脉瘤样夹层、囊状动脉瘤）以及尺寸类别（<3 cm、3.0-3.9 cm、4.0-4.9 cm、≥5.0 cm）对生长情况进行分层。确定了 488 名女性的队列； 286 进行了多次扫描以供审查。整个队列的平均年龄为 75 ± 9.9 岁。按病理类型分层，梭状 AAA 患者的平均年龄为 76 ± 8.9 岁，扩张型 AAA 患者的平均年龄为 74 ± 9.8 岁，夹层动脉瘤患者的平均年龄为 65 ± 13.7 岁，囊状动脉瘤患者的平均年龄为 76 ± 5.6 岁。患有梭形 AAA 的女性的最大生长最高，其次是夹层、扩张和囊状病理（分别为 9.7 毫米、7.0 毫米、3.0 毫米和 2.2 毫米；< .001）。比较每年的平均生长，平均生长最高的是梭状 AAA（3.6 毫米 vs 夹层 1.75 毫米；< .001）。夏皮罗-威尔克检验表明，年平均增长率呈右偏非正态分布。按诊断时的主动脉直径分层，梭状 AAA 和夹层诊断时的平均生长量随着诊断时尺寸的增加而增加（<3 cm 为 0.91 mm，3.0-3.9 cm 为 2.34 mm，4.0-4.9 mm 为 2.49 mm，梭状 AAA 患者≥5.0 cm 为 6.16 mm，夹层患者分别为 0.57 mm、0.94 mm、1.87 mm 和 2.66 mm）。吸烟史与较高的平均年生长量相关（2.6 毫米 vs 3.3 毫米；< .001）。相反，有 AAA 家族史的患者每年平均生长速度较低（3.2 毫米 vs 1.5 毫米；< .001）。女性动脉瘤的生长速度因病理学和动脉瘤大小而异，当女性的动脉瘤尺寸大于 4.5 厘米时，动脉瘤会快速生长。目前的筛查指南并不充分，我们的结果表明，女性梭形动脉瘤的生长速度比男性更快，且尺寸较小，因此可能需要比目前血管外科学会建议更频繁的监测，以防止发病率增加的风险。