title: Abdominal aortic aneurysm screening in elderly males with atherosclerosis: the value of physical exam.
abstract: The purpose was 1) To assess the prevalence of abdominal aortic aneurysms (AAA) in elderly males with atherosclerosis and 2) to evaluate the value of physical exam (PE) by a vascular surgeon in detecting AAA. A total of ninety-six males older than 55 years referred to vascular surgery clinic with atherosclerotic disease were screened prospectively with PE by a vascular surgeon, followed by ultrasonography (US). Atherosclerosis was documented by ankle brachial index and duplex US. Patients who had recently undergone a vascular procedure, aortography, laparotomy, abdominal computed tomography, or US were excluded. Mean age was 67 years. Patients were 67 per cent Caucasian, 32 per cent black, and 1 per cent Hispanic. Presenting complaints were related to claudication (83%), carotid disease (19%), both (3%), and subclavian stenosis (1%). Patient characteristics included cigarette smoking (85%), hypertension (67%), cardiac disease (51%), diabetes (45%), stroke (18%), and chronic obstructive pulmonary disease (8%). One (1%) 3.7 cm AAA was detected by US. Sensitivity of PE was 100 per cent and specificity 92 per cent. Twenty-two (23%) patients were too obese for us to feel the aortic pulse. Screening cost was $14,250. The prevalence of AAA in this population is very low. AAA screening should be reserved for patients with a positive PE or who are too obese for the examiner to feel the aortic pulse.
authors.affiliation: Department of Surgery, Wadsworth Veterans Affairs Medical Center, Los Angeles, California, USA.
authors.forename: T D
authors.initials: TD
authors.lastname: Arnell
authors.forename: C
authors.initials: C
authors.lastname: de Virgilio
authors.forename: C
authors.initials: C
authors.lastname: Donayre
authors.forename: E
authors.initials: E
authors.lastname: Grant
authors.forename: J D
authors.initials: JD
authors.lastname: Baker
authors.forename: R
authors.initials: R
authors.lastname: White
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D001161:Arteriosclerosis / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography