Biomechanical research progress on sex differences of abdominal aortic aneurysm_Journal of Biomedical Engineering

Authors：

LIU Ming ^1,2 , ZHANG Yaxing ^1,2 , GAO Zujie ^1,2 , WANG Zhenze ³ , XI Yifeng ^1,2 ,  SUN Anqiang ^1,2 , DENG Xiaoyan ^1,2

1. Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science & Medical Engineering, Beihang University, Beijing 100191, P.R.China;
2. Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing 102402, P.R.China;
3. National Research Center for Rehabilitation Technical Aids, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Beijing 100176, P.R.China;

Corresponding author：

Keywords：

abdominal aortic aneurysm; biomechanics; sex differences

DOI：

10.7507/1001-5515.201803032

Video：

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The phenomenon of sex differences exists in patients who have abdominal aortic aneurysms (AAA). The occurrence rate of AAA is higher in male, while the rates of rupture and postoperative mortality are higher for female. This phenomenon of sex differences would affect the diagnosis, treatment and postoperative rehabilitation for AAA patients. This article reviewed the recent research status of sex differences on AAA, and explored the phenomenon of sex differences from the aspects of threshold determination, biomechanics and mechanobiology. This review points out that the sex differences on AAA could ascribe to the differences of biomechanical environment and biological properties induced by the vascular size, anatomy structure and structure components of abdominal aortic artery. The comprehensive investigations of the sex differences on AAA could help to optimize the diagnosis, treatment and device design, patient care and rehabilitation strategy of AAA based on sex differences phenomenon.

Citation： LIU Ming, ZHANG Yaxing, GAO Zujie, WANG Zhenze, XI Yifeng, SUN Anqiang, DENG Xiaoyan. Biomechanical research progress on sex differences of abdominal aortic aneurysm. Journal of Biomedical Engineering, 2018, 35(6): 959-963. doi: 10.7507/1001-5515.201803032 Copy

1.	Kumar Y, Hooda K, Li S, et al. Abdominal aortic aneurysm: pictorial review of common appearances and complications. Ann Transl Med, 2017, 5(12): 256.
2.	White V, Wyatt M. Endovascular treatment of abdominal aortic aneurysms. Surgery (Oxford), 2015, 33(7): 334-339.
3.	Desai M, Choke E, Sayers R D, et al. Sex-related trends in mortality after elective abdominal aortic aneurysm surgery between 2002 and 2013 at National Health Service hospitals in England: less benefit for women compared with men. Eur Heart J, 2016, 37(46): 3452-3460.
4.	Johansson M, Harris R P. Thresholds in women with abdominal aortic aneurysm. Lancet, 2017, 389(10088): 2446-2448.
5.	Ulug P, Sweeting M J, von Allmen R S, et al. Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis. Lancet, 2017, 389(10088): 2482-2491.
6.	Sidloff D A, Saratzis A, Sweeting M J, et al. Sex differences in mortality after abdominal aortic aneurysm repair in the UK. Br J Surg, 2017, 104(12): 1656-1664.
7.	Elias F, Tarola C, Hegazy A F, et al. Sex differences in endovascular abdominal aortic aneurysms: a meta-analysis. J Vasc Surg, 2016, 2016, 64(5): 1550.
8.	George J, Rapsomaniki E, Pujades-Rodriguez M, et al. How does cardiovascular disease first present in women and men? Incidence of 12 cardiovascular diseases in a contemporary cohort of 1,937,360 people. Circulation, 2015, 132(14): 1320-1328.
9.	Gloviczki P, Huang Y, Oderich G S, et al. Clinical presentation, comorbidities, and age but not female gender predict survival after endovascular repair of abdominal aortic aneurysm. J Vasc Surg, 2015, 61(4): 853-861.
10.	Deery S E, Soden P A, Zettervall S L, et al. Sex differences in mortality and morbidity following repair of intact abdominal aortic aneurysms. J Vasc Surg, 2017, 65(4): 1006-1013.
11.	Villard C, Hultgren R. Abdominal aortic aneurysm: Sex differences. Maturitas, 2018, 109: 63-69.
12.	Lo R C, Lu Bing, Fokkema M T, et al. Relative importance of aneurysm diameter and body size for predicting abdominal aortic aneurysm rupture in men and women. J Vasc Surg, 2014, 59(5): 1209-1216.
13.	Regnier P, Lareyre F, Hassen-Khodja R, et al. Sexual dysfunction after abdominal aortic aneurysm surgical repair: current knowledge and future directions. Eur J Vasc Endovasc Surg, 2018, 55(2): 267-280.
14.	Taylor W R, Iffrig E, Veneziani A, et al. Sex and vascular biomechanics: A hypothesis for the mechanism underlying differences in the prevalence of abdominal aortic aneurysms in men and women. Trans Am Clin Climatol Assoc, 2016, 127: 148-161.
15.	Liu Xiao, Pu Fang, Fan Yubo, et al. A numerical study on the flow of blood and the transport of LDL in the human aorta: the physiological significance of the helical flow in the aortic arch. Am J Physiol Heart Circ Physiol, 2009, 297(1): H163-H170.
16.	Smulyan H, Asmar R G, Rudnicki A, et al. Comparative effects of aging in men and women on the properties of the arterial tree. J Am Coll Cardiol, 2001, 37(5): 1374-1380.
17.	Gasser T C, Nchimi A, Swedenborg J, et al. A novel strategy to translate the biomechanical rupture risk of abdominal aortic aneurysms to their equivalent diameter risk: method and retrospective validation. Eur J Vasc Endovasc Surg, 2014, 47(3): 288-295.
18.	Lindquist Liljeqvist M, Hultgren R, Siika A, et al. Gender, smoking, body size, and aneurysm geometry influence the biomechanical rupture risk of abdominal aortic aneurysms as estimated by finite element analysis. J Vasc Surg, 2017, 65(4): 1014-1021.
19.	Tran K, Dorsey C, Lee J T, et al. Gender-related differences in iliofemoral arterial anatomy among abdominal aortic aneurysm patients. Ann Vasc Surg, 2017, 44: 171-178.
20.	Ayo D, Blumberg S N, Gaing B, et al. Gender differences in aortic neck morphology in patients with abdominal aortic aneurysms undergoing elective endovascular aneurysm repair. Ann Vasc Surg, 2016, 30: 100-104.
21.	Moll F L, Powell J T, Fraedrich G, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European Society for Vascular Surgery. Eur J Vasc Endovasc Surg, 2011, 41(Suppl 1): S1-S58.
22.	Villard C, Eriksson P, Hanemaaijer R, et al. The composition of collagen in the aneurysm wall of men and women. J Vasc Surg, 2017, 66(2): 579-585.
23.	Ye Z, Austin E, Schaid D, et al. Sex differences in abdominal aortic aneurysm expansion. J Am Coll Cardiol, 2016, 67(41, Suppl): S1-S58.
24.	Sun Anqiang, Tian Xiaopeng, Zhang Nan, et al. Does lower limb exercise worsen renal artery hemodynamics in patients with abdominal aortic aneurysm. PLoS One, 2015, 10(5): e0125121.
25.	Lysgaard Poulsen J, Stubbe J, Lindholt J S. Animal models used to explore abdominal aortic aneurysms: a systematic review. Eur J Vasc Endovasc Surg, 2016, 52(4): 487-499.
26.	Davis J P, Salmon M, Pope N H, et al. Attenuation of aortic aneurysms with stem cells from different genders. J Surg Res, 2015, 199(1): 249-258.
27.	Li W, Luo S, Luo J, et al. Predictors associated with increased prevalence of abdominal aortic aneurysm in Chinese patients with atherosclerotic risk factors. Eur J Vasc Endovasc Surg, 2017, 54(1): 43-49.

1. Kumar Y, Hooda K, Li S, et al. Abdominal aortic aneurysm: pictorial review of common appearances and complications. Ann Transl Med, 2017, 5(12): 256.
2. White V, Wyatt M. Endovascular treatment of abdominal aortic aneurysms. Surgery (Oxford), 2015, 33(7): 334-339.
3. Desai M, Choke E, Sayers R D, et al. Sex-related trends in mortality after elective abdominal aortic aneurysm surgery between 2002 and 2013 at National Health Service hospitals in England: less benefit for women compared with men. Eur Heart J, 2016, 37(46): 3452-3460.
4. Johansson M, Harris R P. Thresholds in women with abdominal aortic aneurysm. Lancet, 2017, 389(10088): 2446-2448.
5. Ulug P, Sweeting M J, von Allmen R S, et al. Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis. Lancet, 2017, 389(10088): 2482-2491.
6. Sidloff D A, Saratzis A, Sweeting M J, et al. Sex differences in mortality after abdominal aortic aneurysm repair in the UK. Br J Surg, 2017, 104(12): 1656-1664.
7. Elias F, Tarola C, Hegazy A F, et al. Sex differences in endovascular abdominal aortic aneurysms: a meta-analysis. J Vasc Surg, 2016, 2016, 64(5): 1550.
8. George J, Rapsomaniki E, Pujades-Rodriguez M, et al. How does cardiovascular disease first present in women and men? Incidence of 12 cardiovascular diseases in a contemporary cohort of 1,937,360 people. Circulation, 2015, 132(14): 1320-1328.
9. Gloviczki P, Huang Y, Oderich G S, et al. Clinical presentation, comorbidities, and age but not female gender predict survival after endovascular repair of abdominal aortic aneurysm. J Vasc Surg, 2015, 61(4): 853-861.
10. Deery S E, Soden P A, Zettervall S L, et al. Sex differences in mortality and morbidity following repair of intact abdominal aortic aneurysms. J Vasc Surg, 2017, 65(4): 1006-1013.
11. Villard C, Hultgren R. Abdominal aortic aneurysm: Sex differences. Maturitas, 2018, 109: 63-69.
12. Lo R C, Lu Bing, Fokkema M T, et al. Relative importance of aneurysm diameter and body size for predicting abdominal aortic aneurysm rupture in men and women. J Vasc Surg, 2014, 59(5): 1209-1216.
13. Regnier P, Lareyre F, Hassen-Khodja R, et al. Sexual dysfunction after abdominal aortic aneurysm surgical repair: current knowledge and future directions. Eur J Vasc Endovasc Surg, 2018, 55(2): 267-280.
14. Taylor W R, Iffrig E, Veneziani A, et al. Sex and vascular biomechanics: A hypothesis for the mechanism underlying differences in the prevalence of abdominal aortic aneurysms in men and women. Trans Am Clin Climatol Assoc, 2016, 127: 148-161.
15. Liu Xiao, Pu Fang, Fan Yubo, et al. A numerical study on the flow of blood and the transport of LDL in the human aorta: the physiological significance of the helical flow in the aortic arch. Am J Physiol Heart Circ Physiol, 2009, 297(1): H163-H170.
16. Smulyan H, Asmar R G, Rudnicki A, et al. Comparative effects of aging in men and women on the properties of the arterial tree. J Am Coll Cardiol, 2001, 37(5): 1374-1380.
17. Gasser T C, Nchimi A, Swedenborg J, et al. A novel strategy to translate the biomechanical rupture risk of abdominal aortic aneurysms to their equivalent diameter risk: method and retrospective validation. Eur J Vasc Endovasc Surg, 2014, 47(3): 288-295.
18. Lindquist Liljeqvist M, Hultgren R, Siika A, et al. Gender, smoking, body size, and aneurysm geometry influence the biomechanical rupture risk of abdominal aortic aneurysms as estimated by finite element analysis. J Vasc Surg, 2017, 65(4): 1014-1021.
19. Tran K, Dorsey C, Lee J T, et al. Gender-related differences in iliofemoral arterial anatomy among abdominal aortic aneurysm patients. Ann Vasc Surg, 2017, 44: 171-178.
20. Ayo D, Blumberg S N, Gaing B, et al. Gender differences in aortic neck morphology in patients with abdominal aortic aneurysms undergoing elective endovascular aneurysm repair. Ann Vasc Surg, 2016, 30: 100-104.
21. Moll F L, Powell J T, Fraedrich G, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European Society for Vascular Surgery. Eur J Vasc Endovasc Surg, 2011, 41(Suppl 1): S1-S58.
22. Villard C, Eriksson P, Hanemaaijer R, et al. The composition of collagen in the aneurysm wall of men and women. J Vasc Surg, 2017, 66(2): 579-585.
23. Ye Z, Austin E, Schaid D, et al. Sex differences in abdominal aortic aneurysm expansion. J Am Coll Cardiol, 2016, 67(41, Suppl): S1-S58.
24. Sun Anqiang, Tian Xiaopeng, Zhang Nan, et al. Does lower limb exercise worsen renal artery hemodynamics in patients with abdominal aortic aneurysm. PLoS One, 2015, 10(5): e0125121.
25. Lysgaard Poulsen J, Stubbe J, Lindholt J S. Animal models used to explore abdominal aortic aneurysms: a systematic review. Eur J Vasc Endovasc Surg, 2016, 52(4): 487-499.
26. Davis J P, Salmon M, Pope N H, et al. Attenuation of aortic aneurysms with stem cells from different genders. J Surg Res, 2015, 199(1): 249-258.
27. Li W, Luo S, Luo J, et al. Predictors associated with increased prevalence of abdominal aortic aneurysm in Chinese patients with atherosclerotic risk factors. Eur J Vasc Endovasc Surg, 2017, 54(1): 43-49.

Journal of Biomedical Engineering

Biomechanical research progress on sex differences of abdominal aortic aneurysm

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