Abstract
Introduction
Abdominal aortic aneurysm (AAA) development is a multifactorial process that is more
prevalent among people ≥65 years of age. Major risk factors are obesity, male sex, history of smoking (at least
100 cigarettes in a person’s lifetime), and history of AAA in a first-degree relative.
The United States Preventative Task Force has recommended a one-time ultrasound screening
for men aged 65–75 years. Based on studies, negative results on a single ultrasound examination around
the age of 65 years appear to virtually exclude the risk for future AAA rupture or death. While
ultrasonography (US) is the confirmatory study of choice, computed tomography (CT)
can also be used in the diagnosis of AAA. The goal of this study is to determine if
AAA rupture can reliably be excluded in individuals with abdominal pain who have had
a normal caliber aorta on CT or US after the age of 65 years.
Materials and methods
A retrospective study (approved by institutional review board) of emergency department
(ED) patients in an urban academic center was performed. Subjects were included if
they met the following criteria: age ≥65 years; an initial CT or US as an ED patient, inpatient, or outpatient for any indication,
which identified an abdominal aorta <3 cm; and a second CT or US during an ED visit. The incidence of ruptured AAA on the
second CT or US with a history of normal aortic caliber was identified.
Results
During the study period, 606 subjects were enrolled. Demographic data are listed in
Table 1. Three subjects (0.5%) exhibited an abnormal-sized aorta on ED evaluation.
None of these three subjects had an AAA intervention. The average size of the abnormal
aorta in these three subjects was 3.3 cm (S.D. 0.17).
Conclusion
Based on these results, it appears that AAA and rupture may reliably be excluded in
ED patients with abdominal pain who have previously had a normal caliber aorta on
CT or US after the age of 65 years. A prospective, multicenter study would help validate these findings.
Keywords
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Article info
Publication history
Published online: December 03, 2015
Accepted:
November 19,
2015
Received in revised form:
November 10,
2015
Received:
July 24,
2015
Footnotes
☆Each of the authors contributed to the study concept and design, analysis, and interpretation of the data and drafting of the manuscript. Dr Martin Lesser was instrumental for his statistical expertise.
☆☆The study was approved by the Staten Island University Hospital Institutional Review Board.
★There was no financial support or conflict of interest of the investigation or manuscript development.
Identification
Copyright
© 2015 Elsevier Inc. All rights reserved.
