Objective:
To systematically quantify the differences in outcomes between men and women being assessed for repair of intact abdominal aortic aneurysm (AAA) in contemporary data (2000 or later).

Methods:
Three systematic reviews were undertaken, according to PRISMA guidelines of studies reporting separately for men and women the proportion morphologically suitable (within Manufacturers’ Instructions for Use) for endovascular repair (EVAR), non-intervention rates, and 30-day mortality after intact aneurysm repair. The minimum numbers for studies in each review were based on inclusion of 20, 20 and 50 women, respectively. Studies (randomised, cohort or cross-sectional) were identified by searching MEDLINE, Embase, CENTRAL and other sources until 2nd September 2016 and quality assessed using the Newcastle–Ottawa scoring system. Results were combined across studies by random-effects meta-analysis. The reviews are registered in PROSPERO: CRD42016043227.

Results:
Five studies evaluated the morphological eligibility for EVAR (1507 men, 400 women). The overall proportion of women eligible for EVAR was much lower than in men, 34% versus 54%, odds ratio 0.44 [95%CI 0.32,0.62]. Four single centre studies reported non-intervention rates (1365 men, 247 women). The overall non-intervention rates were higher in women than men, 34% versus 19%, odds ratio 2.27 [95%CI 1.21,4.23]. The review of 30-day mortality included nine studies (52018 men, 10076 women). The overall estimate for EVAR was higher in women than men: 2.3% versus 1.4%, odds ratio 1.67 [95%CI 1.38,2.04]. The overall estimate for open repair also was higher in women: 5.4% versus 2.8% in men, odds ratio 1.76 [95%CI 1.35,2.30].

Interpretation:
A smaller proportion of women are eligible for EVAR, a higher proportion of women are not offered intervention, and operative mortality was much higher in women for both EVAR and open repair. The management of AAA in women needs improvement.