[Aortic disease in women]

Abdominal aortic disease in women is associated with atheromatous processes much more often than with inflammatory arterial diseases (such as Takayasu or Horton). Intramural hematomas and atheromatous ulcers of the aorta, albeit rare, affect as many women as men and have variable outcomes: some are resolved with heparin treatment, and others are fatal. Atherosclerotic stenoses and occlusions limited to the level of the aortoiliac bifurcation are increasingly prevalent and difficult to treat in young women, in part because of their addiction to smoking. After being more or less ignored for a long time, the particularity of atheromatous abdominal aortic aneurysms (AAA) in women is now being recognized. AAA in women are less frequent than in men, but grow faster and have a higher risk of rupture; moreover, cardiovascular disease is generally detected and managed less often in women. Overall mortality from AAA in women is similar to that of breast cancer. The two major risk factors for AAA are, as in men, a direct family history of AAA and smoking. The diagnostic standards for AAA, the criteria for defining progression, and the indications for surgery are probably not the same as in men, and the smaller initial caliber of women's aortas must be taken into account. Most guidelines today recommend ultrasound screening for AAA for women older than 50 years with a family history (in a 1(st)degree relative), women aged 60-75 years who are hypertensive or smoke, and smokers older than 75 years without serious comorbidity and with a life expectancy essentially normal for their age. Monitoring patients with a small AAA (anteroposterior diameter < 40-45 mm) must not be limited only to the aneurysm, but must also include comprehensive management to eliminate modifiable risk factors and thus to reduce cardiovascular and surgical risk (by better preparing the patient for this possibility) as well as to slow the progression of the aneurysm and decrease the risk of its rupture.