The differences between men and females who present with aortic disease have been discussed increasingly in the literature in recent years. Differences have been reported regarding screening, presentation, disease progression, intervention, and outcomes, and hold regardless of the anatomic location of the aortic aneurysm. Females present at an older age and later to the hospital, have a faster aortic aneurysm growth rate, a higher risk of dying outside of the hospital, and worse aortic-related outcomes when treated for the condition [1], [2], [3].

A few contributors to these differences have been suggested, including the lack of screening protocols for females in many countries [4,5], which may lead to delayed diagnosis. Other theories include older age at presentation and hormonal changes throughout the woman's life, which may contribute to underdiagnosis and undermanagement of cardiovascular risk factors [6]. Some have also suggested that early menopause and shorter reproductive lifespan may be associated with ascending aortic aneurysm, anatomy, and smaller body size of females compared with men, which may present a challenge in operative treatment [7,8].

In this review, we discuss the literature on presentation and outcomes of thoracic and thoracoabdominal aortic aneurysms in females. We will discuss the existing gaps and suggest future directions to address them.