title: Abdominal Aortic Aneurysm Diameters: A Study on the Discrepancy  between Inner to Inner and Outer to Outer Measurements.
abstract: BACKGROUND
  The NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP) uses the maximal anterior to posterior (AP) inner-to-inner (ITI) wall diameter in sizing aortic dimensions when screening with ultrasound. It is recognised that ITI measurements are smaller than outer-to-outer (OTO) measurements, and the primary aim was to calculate the absolute difference in AP ITI and OTO measurements across varying aortic diameters. The secondary aim was to estimate the potential number of patients lost from the screening programme.
  
  
  METHODS
  Since April 2012, patients outside the screening programme that undergo ultrasound of abdominal aortas have their ITI and OTO measurements recorded. These measurements were compared retrospectively and analysed for variability at threshold sizes of AAAs.
  
  
  RESULTS
  From May 2012 to October 2013, 452 abdominal aortic ultransound scans recorded both ITI and OTO measurements. The majority (81%) were performed on men with the mean age of 78 years. The mean difference between ITI and OTO measurements was 4.21 mm (p < .001). There was no difference between the genders. Thresholds were created for analysis between different ITI and OTO aortic diameters; these were <3 cm, 3.1-4 cm, 4.1-5 cm, and >5 cm. There was no significant difference between the means at each threshold size for ITI diameter (p = .758). In the first 2 years from April 2012, 15,447 men underwent screening.Of these, 177 (1.14%) had sub-threshold ITI aortic diameters between 2.6 cm and 2.9 cm. This would upscale to 5,316 men nationally.
  
  
  CONCLUSIONS
  We have demonstrated a consistent and significant 4mm difference between ITI and OTO diameters in live scanning. Lowering the threshold for entry into a surveillance AAAs to an ITI diameter of 26mm rather than the current 30 mm is advocated. An alternative cost-effective way is to rescreen this small sub-group at 5 or 7 years.
authors.forename: L
authors.initials: L
authors.lastname: Meecham
authors.forename: R
authors.initials: R
authors.lastname: Evans
authors.forename: P
authors.initials: P
authors.lastname: Buxton
authors.forename: K
authors.initials: K
authors.lastname: Allingham
authors.forename: M
authors.initials: M
authors.lastname: Hughes
authors.forename: S
authors.initials: S
authors.lastname: Rajagopalan
authors.forename: J
authors.initials: J
authors.lastname: Fairhead
authors.forename: J R
authors.initials: JR
authors.lastname: Asquith
authors.forename: A D
authors.initials: AD
authors.lastname: Pherwani
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging*; D001837:Body Weights and Measures / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012727:Sex Characteristics; D020711:Threshold Limit Values; D014463:Ultrasonography