Abdominal aortic aneurysm screening in elderly males with atherosclerosis: the value of physical exam

The purpose was 1) To assess the prevalence of abdominal aortic aneurysms (AAA) in elderly males with atherosclerosis and 2) to evaluate the value of physical exam (PE) by a vascular surgeon in detecting AAA. A total of ninety-six males older than 55 years referred to vascular surgery clinic with atherosclerotic disease were screened prospectively with PE by a vascular surgeon, followed by ultrasonography (US). Atherosclerosis was documented by ankle brachial index and duplex US. Patients who had recently undergone a vascular procedure, aortography, laparotomy, abdominal computed tomography, or US were excluded. Mean age was 67 years. Patients were 67 per cent Caucasian, 32 per cent black, and 1 per cent Hispanic. Presenting complaints were related to claudication (83%), carotid disease (19%), both (3%), and subclavian stenosis (1%). Patient characteristics included cigarette smoking (85%), hypertension (67%), cardiac disease (51%), diabetes (45%), stroke (18%), and chronic obstructive pulmonary disease (8%). One (1%) 3.7 cm AAA was detected by US. Sensitivity of PE was 100 per cent and specificity 92 per cent. Twenty-two (23%) patients were too obese for us to feel the aortic pulse. Screening cost was $14,250. The prevalence of AAA in this population is very low. AAA screening should be reserved for patients with a positive PE or who are too obese for the examiner to feel the aortic pulse.