Influence of sex on the outcome of ruptured abdominal aortic aneurysm

curve). At the end of the study period, 87 patients 76 per cent) were dead, 26 30 per cent) from a ruptured AAA. Mean survival times were: 23 months 5´5±5´9 cm), 20 months 6´0±7´0 cm) and 15 months greater than 7´0 cm). Conclusion: While recognizing the problems with death certi®cation, rupture still seems to be a signi®cant cause of death in patients with untreated AAAs greater than 5´5 cm. While little difference is observed in 5´5±7´0-cm range, patients with an AAA greater than 7´0 cm seem to have a much poorer prognosis. Effect of propanolol on the expansion of abdominal aortic aneurysms: a randomized study A. B. M. Wilmink, C. S. F. F. Hubbard, N. E. Day and C. R. G. Quick Cambridge Vascular Unit and Hinchingbrooke Hospital, Cambridge, UK Background: This study investigated whether propanolol reduces the growth rate of small screen-detected abdominal aortic aneurysms AAAs). Methods: This was a prospective blinded randomized study of men with an aneurysm between 3 and 4´5 cm detected in a community-based screening programme. Results: Some 477 patients were randomized: 256 to take propanolol 40 mg and 221 controls. The mean growth rate in the propanolol group was 0´06 95 per cent con®dence interval 0±0´14) versus 0´1 0´02±0´19) mm in the control group P = 0´48). Propanolol decreased growth in 59 patients with an AAA larger than 3´9 cm 0´13 0±0´31) versus 0´43 0´26± 0´60) mm in controls; P = 0´02). Compliance with propanolol treatment was poor: 31 per cent of the active treatment group were on beta blockers compared with 15 per cent in the control group. The growth in patients actually taking beta blockers was 0´24 0´11±0´38) versus 0´25 0´17±0´33) mm P = 0´91). Stiffness measurements did not differ signi®cantly between patients taking beta blockers and controls. Subgroup analysis showed an increased stiffness in the patients on beta blockers means.d.) 31´14´2) versus 23´41´9) in controls in aortas larger than 3´4 cm; P = 0´057). Conclusion: Propanolol is not associated with a signi®cant reduction in the growth of small aneurysms. Propanolol reduces the growth of aneurysms larger than 4 cm. Compliance with propanolol treatment for small aneurysms is low. Treatment of small screen-detected aneurysms with propanolol cannot be recommended. In¯uence of sex on the outcome of ruptured abdominal aortic aneurysm P. Norman Department of Surgery, Fremantle Hospital, Fremantle, Western Australia, Australia Background: Mortality rates from ruptured abdominal aortic aneurysm AAA) in men and women were compared. Methods: Patients were identi®ed from a population-based database using the relevant ICD-9-CM codes and were divided into three groups for analysis: those dying without admission to hospital, those admitted to hospital with ruptured AAA but not undergoing surgery, and those who underwent surgery for ruptured AAA. Results: Ruptured AAA occurred in 648 men and 225 women over the age of 55 years during the decade 1985±1994. The proportion of women increased with age from 13´8 per cent for those aged 60±69 years, to 42´3 per cent for those over 80 years of age. Only 49´7 per cent of women 112 of 225), compared with 58´9 per cent of men 382 of 648), with ruptured AAA were admitted to hospital c 2 = 5´35, P = 0´02). Of those admitted to hospital, only 36´6 per cent of women 41 of 112) underwent surgery compared with 63´3 per cent of men 242 of 382) c 2 = 8´71, P = 0´003). The mortality rate in women undergoing surgery was 44 per cent 18 of 41) compared with 34´7 per cent 84 of 242) in men c 2 = 5´35, P = 0´021). The overall mortality rate from ruptured AAA was 89´8 per cent in women 202 of 225) and 75´6 per cent in men 490 of 648) c 2 = 50´34, P < 0´0001). Although women were on average older than men, age-speci®c analysis showed that this unfavourable pattern occurred in all age groups. Conclusion: Women with ruptured AAA are more likely to die than men. The cause of the poor outcome in women is unclear but may be due to the use of thresholds for intervention that are based on aortic diameters in men. Differential expansion rates of small abdominal aortic aneurysms between the apolipoprotein E genotypes J. S. Lindholt, L. U. Gerdes, S. Vammen, D. W. Henneberg and H. Fasting Hospital of Viborg, Viborg, Denmark Background: Carriers of the E4 allele for the gene encoding apolipoprotein E apoE) have an increased risk of athero- sclerosis. The distribution of apoE genotypes among men with a small abdominal aortic aneurysm AAA) was compared with that among healthy men, and any differences between the genotypes in aneurysm expansion measured over 2±4´5 years were examined. Methods: The patients originate from a population ultrasono- graphic screening programme with about 4800 participating 65±73-year-old men in a de®ned geographical region. Of 191 patients diagnosed, 57 of 77 who have been followed for 2 years or more were genotyped. Aneurysm expansion rates were determined from linear regression of diameter versus time of examination. The in¯uence of apoE genotype on expansion rate was analysed using analysis of variance, with initial aneurysm size and smoking status as covariates. Results: The E4E4 genotype was not seen among patients with an AAA, whereas three patients had the rare E2E4 genotype. These patients had higher expansion rates than patients with the common genotype E3E3 P = 0´009), whereas patients with the genotype E3E4 had lower rates P = 0´034) see Table over). VSSGBI abstracts 499 ã 2000 Blackwell Science Ltd www.bjs.co.uk British Journal of Surgery 2000, 87, 490±516

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Influence of sex on the outcome of ruptured abdominal aortic aneurysm