Aortic Pathology and Peripheral Arterial Disease in Women

Cardiovascular diseases (CVD) represent a major health care burden and are the leading cause of mortality in Western Society. Of the CVD lower limb peripheral arterial disease (PAD) is understudied despite its high global prevalence (>230 million people), which is expected to increase substantially in the next decades, and its excessively high risk of major adverse cardiovascular (MACE) and limb events (MALE). Another vascular disease that has major impact on survival, despite a global declining prevalence, are abdominal aortic aneurysms (AAA). Both PAD and AAA have sex-specific characteristics. In general women are less likely to receive secondary preventive medical management according to guidelines. Although prevalence of PAD in women is at least similar to that in men, women present more often with atypical symptoms. Moreover, women are less likely to undergo revascularization for PAD, and often at a later stage and older age. Furthermore, they tend to undergo less open revascularizations than men. Despite these differences reported sex-specific prognosis of PAD is divergent. The prevalence of AAA is lower in women than in men, however women with AAA do much worse than men. AAA in women tend to grow faster and women are more often not suitable for regular endovascular aneurysm repair (EVAR). Furthermore, women have higher complication and mortality rates after both elective and emergent repair (both open and endovascular). Undoubtedly, sex plays an important role in the prevalence, management and outcome of both PAD and AAA. Female specific data is often lacking and women are underrepresented in clinical studies. Future studies should aim to increase the engagement of women in clinical trials and at least report sex-specific data to improve knowledge on and outcome of CVD in women.