This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Frank A. Lederle, MD; Janine M. Walker, RN; Donovan B. Reinke, MD

Arch Intern Med. 1988;148(8):1753-1756.

Abstract
• Abdominal aortic aneurysm (AAA) is an important cause of preventable death in older persons. Persistently high rupture mortality rates indicate that these deaths can be prevented only by early detection and treatment of AAA. In an effort to develop an effective and efficient program of AAA detection, we selectively screened a high-risk population. Men aged 60 to 75 years with hypertension and/or coronary artery disease were randomly selected from a general medicine clinic and screened with physical examination and ultrasound. Eighteen previously unsuspected aneurysms, 3.6 to 5.9 cm in size (mean, 4.4 cm), were detected in 201 patients, for a prevalence of 9% (95% confidence interval: 4.7% to 13.3%). The specificity and positive predictive value of ultrasound were each 100%. Abdominal palpation detected only half of these aneurysms, but missed none in patients with an abdominal girth less than 100 cm (n=6). This degree of sensitivity did not occur with "routine" examinations and requires that the examination be directed specifically toward AAA detection. We conclude that undiagnosed AAAs are common in this large subgroup of the clinic population, that ultrasound is an excellent screening test for AAAs, and that physical examination may be adequate for screening thin patients. We recommend that every two or three years persons over the age of 50 years undergo careful abdominal palpation aimed at detecting AAAs, as part of the periodic health examination. We further recommend that obese older men at high risk for AAA have at least one-time screening with abdominal ultrasound, regardless of findings on physical examination.

(Arch Intern Med 1988;148:1753-1756)

Author Affiliations
From the Department of Medicine, Division of General Internal Medicine (Dr Lederle and Ms Walker), and the Department of Diagnostic Radiology (Dr Reinke), Minneapolis Veterans Administration Medical Center, University of Minnesota.

Footnotes
Accepted for publication April 13, 1988.

Presented in part at the midwest meeting of the American Federation for Clinical Research, Chicago, Nov 13, 1987.

Reprint requests to Department of Medicine III-0, Minneapolis Veterans Administration Medical Center, 54th Street and 48th Avenue S, Minneapolis, MN 55417 (Dr Lederle).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

ACCF/AHA/ACP 2009 competence and training statement: a curriculum on prevention of cardiovascular disease.
American College of Cardiology Foundation et al.
J Am Coll Cardiol 2009;54:1336-1363.
FULL TEXT  

ACCF/AHA/ACP 2009 Competence and Training Statement: A Curriculum on Prevention of Cardiovascular Disease: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Competence and Training (Writing Committee to Develop a Competence and Training Statement on Prevention of Cardiovascular Disease): Developed in Collaboration With the American Academy of Neurology; American Association of Cardiovascular and Pulmonary Rehabilitation; American College of Preventive Medicine; American College of Sports Medicine; American Diabetes Association; American Society of Hypertension; Association of Black Cardiologists; Centers for Disease Control and Prevention; National Heart, Lung, and Blood Institute; National Lipid Association; and Preventive Cardiovascular Nurses Association
WRITING COMMITTEE MEMBERS et al.
Circulation 2009;120:e100-e126.
FULL TEXT  

Abdominal Aortic Aneurysm Screening: Recommendations and Controversies
Longo and Upchurch
VASC ENDOVASCULAR SURG 2005;39:213-219.
ABSTRACT  

Screening for Abdominal Aortic Aneurysm: A Best-Evidence Systematic Review for the U.S. Preventive Services Task Force
Fleming et al.
ANN INTERN MED 2005;142:203-211.
ABSTRACT | FULL TEXT  

Whole-Body 3D MR Angiography of Patients with Peripheral Arterial Occlusive Disease
Herborn et al.
Am. J. Roentgenol. 2004;182:1427-1434.
ABSTRACT | FULL TEXT  

Ultrasonographic Screening for Abdominal Aortic Aneurysms
Lederle
ANN INTERN MED 2003;139:516-522.
ABSTRACT | FULL TEXT  

Small Abdominal Aortic Aneurysms
Powell and Greenhalgh
NEJM 2003;348:1895-1901.
FULL TEXT  

Detection of Atherosclerosis: Systemic Imaging for Systemic Disease with Whole-Body Three-dimensional MR Angiography-- Initial Experience
Goyen et al.
Radiology 2003;227:277-282.
ABSTRACT | FULL TEXT  

The Accuracy of Physical Examination to Detect Abdominal Aortic Aneurysm
Fink et al.
Arch Intern Med 2000;160:833-836.
ABSTRACT | FULL TEXT  

Avoiding the Unintended Consequences of Growth in Medical Care: How Might More Be Worse?
Fisher and Welch
JAMA 1999;281:446-453.
ABSTRACT | FULL TEXT  

Does This Patient Have Abdominal Aortic Aneurysm?
Lederle and Simel
JAMA 1999;281:77-82.
ABSTRACT | FULL TEXT  

Evaluation of Abdominal Aortic Aneurysms
Lalka et al.
PERSPECT VASC SURG ENDOVASC THER 1999;10:43-68.
ABSTRACT  

Laparotomy for Presumed Ruptured Abdominal Aortic Aneurysm: Outcome of Deceptive Emergencies
Melin et al.
VASC ENDOVASCULAR SURG 1997;31:523-530.
ABSTRACT  

Reliability and Accuracy of Physical Examination in Detection of Abdominal Aortic Aneurysms
Kiev et al.
VASC ENDOVASCULAR SURG 1997;31:143-146.
ABSTRACT  

Screening for Abdominal Aortic Aneurysms in a Hypertensive Patient Population
Simon et al.
Arch Intern Med 1996;156:2081-2084.
ABSTRACT  

Risk Factors for Abdominal Aortic Aneurysms in Older Adults Enrolled in the Cardiovascular Health Study
Alcorn et al.
Arterioscler. Thromb. Vasc. Bio. 1996;16:963-970.
ABSTRACT | FULL TEXT  

Abdominal Aortic Aneurysm
Ballard et al.
NEJM 1993;329:1275-1277.
FULL TEXT  

Advances in Diagnostic Imaging and Overestimations of Disease Prevalence and the Benefits of Therapy
Black and Welch
NEJM 1993;328:1237-1243.
FULL TEXT  

Management of Small Abdominal Aortic Aneurysms: Early Surgery vs Watchful Waiting
Katz et al.
JAMA 1992;268:2678-2686.
ABSTRACT  

The Epidemiologic Necropsy for Abdominal Aortic Aneurysm
Wright
JAMA 1991;266:1217-1218.
ABSTRACT  

The Epidemiologic Necropsy for Abdominal Aortic Aneurysm
McFarlane
JAMA 1991;265:2085-2088.
ABSTRACT  

Management of the patient with intermittent claudication
Cooke and Creager
Vasc Med 1991;2:19-31.
 

Positive-Predictive Value of Clinical Suspicion of Abdominal Aortic Aneurysm
LEDERLE
Arch Intern Med 1990;150:2592-2592.
ABSTRACT  

Management of Small Abdominal Aortic Aneurysms
Lederle
ANN INTERN MED 1990;113:731-732.
ABSTRACT  

Positive Predictive Value of Clinical Suspicion of Abdominal Aortic Aneurysm: Implications for Efficient Use of Abdominal Ultrasonography
Beede et al.
Arch Intern Med 1990;150:549-551.
ABSTRACT  

Aortic Aneurysm in a 74-year-old Man with Coronary Disease and 0bstructive Lung Disease: Is Double Jeopardy Enough?
Hagen et al.
Med Decis Making 1989;9:285-299.
 

Selective Screening for Abdominal Aortic Aneurysms With Physical Examination and Ultrasound
BALLARD
Arch Intern Med 1989;149:1463-1466.
ABSTRACT