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Screening for abdominal aortic aneurysms during cardiac catheterization
B S Benzaquen1, P Garzon, M J Eisenberg
1Division of Cardiology, Jewish General Hospital, Suite A-120, 3755 Cote St. Catherine Road, Montreal, Quebec, H3T-1E2, Canada.
Insights
Routine cardiac catheterization can identify undiagnosed abdominal aortic aneurysms (AAA). This screening is inexpensive, easily performed, and should be a standard part of the procedure for patients with AAA risk factors.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Diagnostic Imaging
Background:
- Routine screening for abdominal aortic aneurysms (AAA) is recommended by many authorities.
- Patients undergoing cardiac catheterization frequently present with AAA risk factors.
- The clinical utility of AAA screening during cardiac catheterization warrants evaluation.
Purpose of the Study:
- To assess the effectiveness of screening for abdominal aortic aneurysms (AAA) during cardiac catheterization.
- To determine if AAA can be incidentally detected during this common cardiac procedure.
Main Methods:
- Prospective examination of the abdominal aorta in 127 patients undergoing cardiac catheterization.
- Primary imaging technique: panning down during left ventriculography.
- Secondary imaging: formal abdominal aortogram if catheter advancement was difficult.
- Off-line analysis of aortic morphology and diameters.
Main Results:
- Adequate visualization of the abdominal aorta was achieved in 99 patients (78%).
- Previously undiagnosed, asymptomatic abdominal aortic aneurysms (AAA) were detected in 8% of patients.
- Difficulty advancing the catheter during cardiac catheterization was an independent predictor of AAA presence (OR=11.1).
Conclusions:
- Cardiac catheterization provides an opportunity to identify undiagnosed abdominal aortic aneurysms (AAA).
- Screening for AAA during cardiac catheterization is cost-effective and simple to implement.
- Incorporating AAA screening into routine cardiac catheterization procedures is advisable.
Background:
Many authorities advocate routine screening for abdominal aortic aneurysms (AAA). Patients undergoing cardiac catheterization often have risk factors for AAA. The purpose of this study was to evaluate the clinical utility of screening for AAA during cardiac catheterization.
Methods:
We prospectively examined the abdominal aorta in 127 patients undergoing diagnostic cardiac catheterization. Panning down during left ventriculography was the primary method for imaging the abdominal aorta. However, if there was difficulty advancing the catheter into the abdominal aorta, a formal postero-anterior abdominal aortogram was obtained. Off-line analysis of aortic morphology and diameters was performed.
Results:
We achieved adequate visualization of the abdominal aorta in 99 of 127 patients. Mean age was 67 years; 75% were male. Risk factors for AAA were common, and included: history of smoking (88%); angina (84%); hypertension (57%); hyperlipidemia (52%); previous myocardial infarction (39%); diabetes mellitus (30%); obesity (21%); congestive heart failure (17%); presence of peripheral vascular disease (14%); and previous peripheral vascular procedures (12%). Panning down during left ventriculography was performed in 89% of cases in the 30 degrees right anterior oblique position. Previously undiagnosed, asymptomatic abdominal aortic aneurysms were found in 8 of 99 patients (8%). The mean intraluminal aneurysmal diameter was 2.8 +/- 1.1 cm and the mean length was 5.4 +/- 1.8 cm. Abdominal ultrasonography was performed in 7 of these cases (1 patient refused), and the mean diameter measured was 3.8 +/- 1.4 cm. Peripheral vascular disease, previous peripheral vascular surgery and difficulty advancing the catheter during the procedure were associated by univariate analysis with the presence of AAA. Multivariate analysis demonstrated that difficulty threading the catheter was the only independent predictor of the presence of AAA (odds ratio = 11.1; 95% confidence interval = 4.6-26.6; p = 0.007).
Conclusion:
Undiagnosed abdominal aortic aneurysms can be identified during routine examination of the abdominal aorta during cardiac catheterization. Because screening for AAA during cardiac catheterization is inexpensive and easily performed, it should be a routine part of the examination.