The FINANCIAL — Women die more often than men following treatment for a dilated abdominal aorta. They are more prone to suffering a ruptured aorta, resulting in a need for acute surgery.
They also tend to have serious complications. Women are treated too late, and the recently developed surgical technique is less suitable for them. Nathalie Grootenboer, physician-researcher at Erasmus MC, devoted her PhD research to these topics. In her dissertation, she states that lives can be saved by more accurate diagnosis and an adapted surgical technique.
About two thousand people die each year in the Netherlands due to a ruptured artery. This rupture is the result of a dilatation of the artery. The most common place for a rupture is in the aorta in the abdomen. A dilated artery is often discovered by accident during an ultrasound or scan conducted for other purposes. There are usually no obvious symptoms. As a result, most people are unaware of the fact that they have an aneurysm. Hemorrhaging from a ruptured artery in the abdomen is usually fatal. More than half of patients die before arriving at the hospital. Of those that make it to the OR, another half die during or shortly after surgery. The risk of developing an aneurysm increases after the age of fifty.
Nathalie Grootenboer, physician-researcher: “In practice, we say that an artery is dilated when the diameter is greater than three centimeters. Treatment is initiated when the diameter of the artery is more than five-and-a-half centimeters. This guideline was developed based on research among primarily male subjects. On average, women have smaller arteries than men, meaning they are already in a more critical condition before treatment is commenced. It is far more accurate to speak of a dilated artery when the diameter is one-and-a-half times greater than normal. We can then diagnosis a dilated artery much sooner, and women can be treated far more effectively. The chance of a ruptured artery is then reduced.”
Women die earlier than men following both acute and planned operations. The new surgical technique in which a stent is introduced through the groin results in twice as many deaths among women compared to men. Women also suffer more serious complications such as myocardial infarction and hemorrhaging during or shortly after surgery. The surgery also fails more often in women, the treatment takes longer or additional operations may also be needed. “This can partly be explained by anatomy. The instrumentation is more suitable for men than for women,” says Grootenboer.
In addition to improving diagnosis and treatment, it is also important to raise awareness, according to Grootenboer. “Many women do not realize that heart and vascular disease is the leading cause of death. Even among those who are aware of this fact, many have no idea about the effects of certain risk factors such as diabetes, hypertension and smoking.”
Nathalie Grootenboer received her PhD on Wednesday, November 7, 2012.
Erasmus MC is the largest and most authoritative scientific University Medical Center in the Netherlands.
