Women’s Vascular Summit hears of ‘changing’ AAA landscape in females

Since conducting an initial U.S. population-based study of gendered abdominal aortic aneurysm (AAA) trends spanning 40 years, Indrani Sen, MBBS, an assistant professor of surgery in the Mayo Clinic Health System, has used what she and colleagues found as a launchpad to delve into the specific differences women experience seeking diagnosis and treatment. The details of the study were presented at the 2023 Women’s Vascular Summit.

Breaking new ground, Sen’s previous research—led by senior researcher Manju Kalra, MBBS, a professor of surgery in Mayo’s division of vascular and endovascular surgery— used the Rochester Epidemiology Project to collect population-based data, finding that aneurysms are diagnosed and treated almost a decade later than in men.

“In our previous study, we essentially found that women who were not repaired had the highest aneurysm-related mortality—rupture was significantly higher in these women,” Sen reflected in conversation with Vascular Specialist ahead of her WVS presentation. “We also found that aneurysms are diagnosed at a smaller size in women, but eventual rupture rates did not differ. This led us to question if ruptures in women should be repaired at a smaller size.” Driving Sen to investigate further, her new research scrutinizes the clinical causes behind why women experience a delay to diagnosis and treatment and who is making the decisions behind this.

“Reports have said that women lose the ability to be fixed by developing advanced arterial disease or other comorbidities that take over. This then means they are no longer eligible for aneurysm repair—and that’s not uncommon today. As the population ages, we are seeing the trend move, with patient diagnosis coming much later, specifically in women,” Sen elaborated.

Importantly their recent research raises various questions surrounding AAA screening for women, which has historically been viewed as cost-ineffective as the disease is “more common” in men. Sen emphasized this fact too, making clear that AAA is still a “disease in men.” However, complex aneurysms are being more frequently seen in women, with Sen noting that the diagnostic landscape for women is “certainly changing.”

Addressing the issues incidental aneurysm detection causes in women, Sen’s presentation recognized a cross-section of challenges that make diagnosis difficult. One may be due to the presence of comorbidities, she noted, which make women “reluctant” to undergo treatment—“it is often not the surgeon saying we can’t do it, but the patient,” Sen com- mented. Nodding to the complex pathway to diagnosis women may face, she noted that even if women are able to be screened and qualified—“who covers the cost? If a woman has a history of smoking, a family history of aneurysm, or any comorbidities—who covers that cost?” she reasoned.

Having presented the first iteration of this research at multiple conferences, Sen pointed out they received “pindrop silence” when it came to discussion. The sole question asked, she said, was from a moderator, who wanted Sen to elaborate on why, if women have smaller aneurysms, they still die. Taking this in stride, Sen used the experience to conduct her current research—making it a core part of her “rationale”—to elucidate her peers and bring awareness to the experience of women with AAAs.—