Abdominal aortic aneurysms in women - Authors' reply.

06 Feb 2018

We thank Kosmas Paraskevas for his interest in our study.The practice of medicine should be based on the best available evidence. The best evidence for when women lose their morphological suitability for endovascular aneurysm repair (EVAR) comes from the study of Sweet and colleagues, which showed that attenuation of the proportion of women suitable for EVAR comes only after the 5·5 cm threshold has been reached.It is well recognised that surgical mortality for most procedures increases with age, and increasing age might be one factor that influences the decision as whether to offer a woman EVAR. There are important competing risks to consider when offering any surgery with substantial operative mortality. Robust evidence for what age or aortic diameter a woman should be offered EVAR to maximise life-expectancy, quality of life, or cost-effectiveness does not exist. The new European Society of Vascular Surgery guidelines for the management of patients with abdominal aortic aneurysm (currently under review) are likely to recommend a threshold aortic diameter of 5·0 cm for intervention in women, but the uncertainty of the evidence is reflected by the level C, class 2b classification provisionally given to this evidence under the American Heart Association and European Society of Cardiology grading system. As such, Johansson and Harris are correct in pointing out that ideally “we need better evidence”