title: Abdominal aortic aneurysm in patients affected by intermittent claudication: prevalence and clinical predictors.
abstract: BACKGROUND
  Abdominal aortic aneurysm (AAA) is a frequent cause of death among elderly. Patients affected by lower extremity peripheral arterial disease (LE-PAD) seem to be particularly at high risk for AAA. We aimed this study at assessing the prevalence and the clinical predictors of the presence of AAA in a homogeneous cohort of LE-PAD patients affected by intermittent claudication.
  
  
  METHODS
  We performed an abdominal ultrasound in 213 consecutive patients with documented LE-PAD (ankle/brachial index ≤ 0.90) attending our outpatient clinic for intermittent claudication. For each patient we registered cardiovascular risk factors and comorbidities, and measured neutrophil count.
  
  
  RESULTS
  The ultrasound was inconclusive in 3 patients (1.4%), thus 210 patients (169 males, 41 females, mean age 65.9 ± 9.8 yr) entered the study. Overall, AAA was present in 19 patients (9.0%), with a not significant higher prevalence in men than in women (10.1% vs 4.9%, p = 0.300). Patients with AAA were older (71.2 ± 7.0 vs 65.4 ± 9.9 years, p = 0.015), were more likely to have hypertension (94.7% vs 71.2%, p = 0.027), and greater neutrophil count (5.5 [4.5 - 6.2] vs 4.1 [3.2 - 5.5] x 10(3)/μL, p = 0.010). Importantly, the c-statistic for neutrophil count (0.73, 95% CI 0.60 - 0.86, p = 0.010) was higher than that for age (0.67, CI 0.56-0.78, p = 0.017). The prevalence of AAA in claudicant patients with a neutrophil count ≥ 5.1 x 10(3)/μL (cut-off identified at ROC analysis) was as high as 29.0%.
  
  
  CONCLUSIONS
  Prevalence of AAA in claudicant patients is much higher than that reported in the general population. Ultrasound screening should be considered in these patients, especially in those with an elevated neutrophil count.
authors.affiliation: Department of Clinical Medicine and Cardiovascular and Immunological Sciences, Federico II University, via Pansini 5, 80131 Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giugliano
authors.forename: Eugenio
authors.initials: E
authors.lastname: Laurenzano
authors.forename: Carlo
authors.initials: C
authors.lastname: Rengo
authors.forename: Giovanna
authors.initials: G
authors.lastname: De Rosa
authors.forename: Linda
authors.initials: L
authors.lastname: Brevetti
authors.forename: Anna
authors.initials: A
authors.lastname: Sannino
authors.forename: Cinzia
authors.initials: C
authors.lastname: Perrino
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Chiariotti
authors.forename: Gabriele Giacomo
authors.initials: GG
authors.lastname: Schiattarella
authors.forename: Federica
authors.initials: F
authors.lastname: Serino
authors.forename: Marco
authors.initials: M
authors.lastname: Ferrone
authors.forename: Fernando
authors.initials: F
authors.lastname: Scudiero
authors.forename: Andreina
authors.initials: A
authors.lastname: Carbone
authors.forename: Antonio
authors.initials: A
authors.lastname: Sorropago
authors.forename: Bruno
authors.initials: B
authors.lastname: Amato
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.forename: Giovanni
authors.initials: G
authors.lastname: Esposito
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications*; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications*; D015995:Prevalence; D012372:ROC Curve; D012307:Risk Factors; D014463:Ultrasonography