This thesis describes the search for an explanation why women with abdominal aortic aneurysm (AAA) have poorer outcomes than men. The first part of this thesis focuses on the high perioperative mortality risk in women and encompasses clinical studies, addressing patient and hospital-related factors. Differences in baseline comorbidities between women and men undergoing elective AAA repair were evaluated. Beyond patient characteristics, the possible influence of hospital-related factors such as hospital volume was investigated. Since the mortality risk is profoundly high in women who undergo elective open surgical repair (OSR) of AAA, causes of death and risk factors for mortality in these women were assessed. The second part of this thesis focuses on the potential role of follicle stimulating hormone (FSH) in the development/progression of AAA in postmenopausal women. This novel hypothesis is first outlined, after which immunohistochemistry is performed to detect the FSH receptor (FSHR). Experiments to assess FSHR gene expression and the effects of FSH stimulation in various extragonadal cells related to AAA are also presented.