Ultrasound screening of the abdominal aorta in patients with intermittent claudication

The presence of abdominal aortic dilatations and aneurysms (AAA) among 372 patients (302 men and 70 women) who originally presented with intermittent claudication was studied. The cohort was analysed in two ways, first retrospectively from the date of diagnosis of intermittent claudication until 1st of August 1985 (mean follow-up time being 70 months), second those alive at that date and who had not been operated on were offered ultrasound screening of their aorta. Retrospectively nine male patients were found to have had an operation for an aneurysm, one because of a rupture. Of the 110 patients who died and had not had surgery, 88 (73 men, 15 women) were autopsied and AAA was found at autopsy in six males and one female. Two males died of rupture. Ultrasonographic screening of the abdominal aorta was performed in 183 patients (147 men and 36 women) and dilatation was found in 25 patients (24 men, 1 woman). In the male part of the total material (n = 257) there were 39 patients (15%) with aneurysm or dilatation. Male patients with AAA or dilated aortas were significantly heavier, with a lower ankle arm index and higher serum cholesterol values than patients without AAA or aortic dilatation.     

High prevalence of abdominal aortic aneurysm in men with peripheral vascular disease: screening by ultrasonography

A study was carried out to see if an ultrasonic examination of the abdominal aorta was indicated in every patient who attended an outpatient clinic with peripheral vascular disease (PVD). One hundred consecutive patients were studied and compared with a control group. The incidence of abdominal aortic aneurysm (AAA) in the control group was 2 per cent. In the study group, the male patients had an incidence of 20 per cent of aneurysm and ectasia, while the female patients had an incidence of 12 per cent. Of all the abnormal aortas found by ultrasound, only 31 per cent were palpable clinically. Two aneurysms that required operation were found, while the remainder are to be followed by regular ultrasound assessment. Further studies are necessary to conclude if screening of a high risk group, such as patients with PVD, is worthwhile.     

Ultrasound screening of first-degree relatives of patients with an abdominal aortic aneurysm

The pedigrees were constructed of 43 patients (probands) who underwent resection of an abdominal aortic aneurysm. Seven probands (16.2%) had a first-degree relative (parent, sibling, child) known to have had an abdominal aortic aneurysm (multiplex family). To determine the prevalence of undiagnosed abdominal aortic aneurysm, ultrasound screening of first-degree relatives over age 40 years was undertaken. Of 202 eligible relatives, 103 (51.0%) were screened. An occult abdominal aortic aneurysm was defined as an infrarenal aortic diameter greater than 3.0 cm or an infrarenal/suprarenal aortic diameter ratio of greater than 1.5. An incipient abdominal aortic aneurysm was defined as a clear focal bulge of the infrarenal aorta, which was less than 3.0 cm in greatest diameter. Four of 103 relatives (3.9%) were found to have an occult abdominal aortic aneurysm (age/sex: 57M, 60M, 62F, 65M), and three (2.9%) were found with an incipient abdominal aortic aneurysm (age/sex: 56M, 60M, 67F). These smaller abdominal aortic aneurysms were in patients younger than the operated probands (average age men, 67 years; women, 69 years). Six of seven individuals were in families previously considered simplex, increasing the actual multiplex family frequency from 16.2% to 27.9%. All seven new abdominal aortic aneurysms were found in the 49 siblings age 55 years or older. There were no abdominal aortic aneurysms found in the 39 relatives under age 55 years, in 14 children ages 50 to 59 years or in one parent. Therefore of the siblings age 55 years or older, 5/20 men (25.0%) and 2/29 women (6.9%) were found to have a previously undiagnosed abdominal aortic aneurysm.(ABSTRACT TRUNCATED AT 250 WORDS)     

ULTRASOUND SCREENING OF THE ABDOMINAL AORTA IN MALAYSIANS

Ultrasound examination of the abdominal aorta was performed on 100 patients with cardiovascular disease and a control group of 100 subjects. The objectives were to define the normal aortic size of Malaysians, to screen for aneurysms and to compare the aorta size of the different population groups. In the study group the mean anteroposterior (AP) diameter of the non-aneurysmal aortas at the level of the renal arteries was 1.82cm (range 0.9–2.6cm) in men and 1.83cm (range 1.5–2.3cm) in women. This compares with 1.61 cm (range 1.1–2.2cm) in men and 1.50cm (range 0.8–2.4cm) in women in the control group. The dimensions of the infrarenal aorta show a similar relationship between the two groups. These AP diameters were significantly smaller than the published figures from studies done on Western populations and are consistent with the smaller stature of Malaysians. Five aneurysms and one ectasia were found (mean size 5cm, range 3.5–6.0cm). all in men aged 50–75 years in the study group, and none in the control group. All the aneurysms were easily palpable in these patients who were thinner than the average Caucasian. Given the lower incidence of aortic aneurysms in Malaysians there is no role for routine ultrasound screening of the population. High risk groups can be adequately screened by clinical examination alone.     

Prevalence of abdominal aortic aneurysm in patients with occlusive peripheral vascular disease

Over a 1-year period, 242 patients with peripheral vascular disease underwent abdominal ultrasonography to detect the presence of an abdominal aortic aneurysm. In 34 (14 per cent) an abdominal aortic aneurysm was found; half of these aneurysms were greater than 4 cm in diameter. In addition, 16 patients had ectatic aortas. Abdominal aortic aneurysms were more common in men than in women (17 versus 8 per cent). Patients with claudication were as likely to have an abdominal aortic aneurysm as those with rest pain or gangrene. The presence of aortoiliac occlusive disease increased the chance of an aneurysm being present (P less than 0.02). Patients with occlusive peripheral vascular disease are a high-risk group with regard to the development of an abdominal aortic aneurysm. Patients with proximal occlusive disease represent a subgroup at even higher risk.     

Abdominal aortic aneurysm as an incidental finding in abdominal ultrasonography

The difference between the mortality rate from ruptured abdominal aortic aneurysm (overall mortality rate 85-95 per cent and operative mortality rate 23-63 per cent), and that for elective aneurysm repair (less than 5 per cent) is dramatic. Awareness of the existence of an abdominal aortic aneurysm is therefore essential. Of 1800 consecutive patients aged greater than or equal to 50 years referred for their first abdominal ultrasonography, 113 who had been referred specifically for suspected abdominal aortic aneurysm or vascular screening were excluded. The remaining 1687 patients (693 men and 994 women) form the study group. Apart from the symptom-directed examination, the entire abdomen of every patient was routinely studied by ultrasonography. The definition of an abdominal aortic aneurysm was a local dilatation of the aorta with an anteroposterior diameter greater than 30 mm or greater than 1.5 times the anteroposterior diameter of the proximal aorta. In 82 cases (4.9 per cent) an abdominal aortic aneurysm was disclosed; 61 were in men (8.8 per cent) and 21 were in women (2.1 per cent). The prevalence of abdominal aortic aneurysm as an incidental finding in men aged greater than or equal to 60 years was 11.4 per cent. In every patient aged greater than or equal to 50 years undergoing their first abdominal ultrasonography examination, the aorta should be screened for the presence of an aneurysm.     

Risk of developing an abdominal aortic aneurysm after ectatic aorta detection from initial screening

ObjectiveCurrent abdominal aortic aneurysm (AAA) surveillance guidelines lack any follow-up recommendations after initial abdominal aortic screening diameter of less than 3.0 cm. Some reports have demonstrated patients with late AAA formation and late ruptures after initial ultrasound screening detection of patients with an aortic diameter of 2.5 to 2.9 cm (ectatic aorta). The purpose of this study was to determine ectatic aorta prevalence, AAA development, rupture risk, and risk factor profile in patients with detected ectatic aortas in a AAA screening program.MethodsA retrospective chart review of all patients screened for AAA from January 1, 2007, to December 31, 2016, within a regional health care system was conducted. Screening criteria were men 65 to 75 years of age that smoked a minimum of 100 cigarettes in their lifetime. An ectatic aorta was defined as a maximum aortic diameter from 2.5 to 2.9 cm. An AAA was defined as an aortic diameter of 3 cm or greater. Patients screened with ectatic aortas who had subsequent follow-up imaging of the aorta with a minimum of 1-year follow-up were analyzed for associated clinical and cardiovascular risk factors. All data were collected through December 3,/2018. A logistic regression of statistically significant variables from univariate and χ² analyses were performed to identify risks associated with the development of AAA from an initially diagnosed ectatic aorta. A Cox proportional hazard model was used to assess survival data. A P value of less than .05 was considered statistically significant.ResultsFrom a screening pool of 19,649 patients, 3205 (16.3%) with a mean age of 72.1 ± 5.3 years were identified to have an ectatic aorta from January 1, 2007, to December 31, 2016. The average screening ectatic aortic diameter was 2.6 ± 0.1 cm. There were 672 patients (21.0%) with a mean age of 73.0 ± 5.7 years who received subsequent imaging for other clinical indications and 193 of these patients (28.7%) with ectatic aortas developed an AAA from the last follow-up scan (4.2 ± 2.5 years). The average observation length of all patients was 6.4 ± 2.9 years. No ruptures were reported, but 27.8% of deaths were of unknown cause. One patient had aortic growth to 5.5 cm or greater (0.15%). Larger initial screening diameter (P < .01), presence of chronic obstructive pulmonary disease (P < .01), and active smoking (P = .01) were associated with AAA development.ConclusionsPatients with diagnosed ectatic aortas from screening who are active smokers or have chronic obstructive pulmonary disease are likely to develop an AAA.     

A community screening programme for abdominal aortic aneurysms

Three-hundred and sixty-nine unselected men aged 65-79 years were invited for screening for abdominal aortic aneurysm. One hundred and forty-one men were examined and 4 aneurysms detected. 43.2% of men aged 65-74 attended for examination in response to a single unsolicited letter of explanation with the date of an appointment, but only 29.1% of those aged 75-79 years. It is suggested that community mortality from ruptured aortic aneurysm could be reduced by ultrasound screening of the aorta in men aged 65-74 years and early selective aneurysm surgery.     

Prevalence of abdominal aortic aneurysm in a hypertensive population.

Two studies were undertaken to estimate the prevalence of abdominal aortic aneurysm in a hypertensive population. The initial study screened hypertensive people from three local general practices. In this study 918 patients underwent ultrasound scanning of the abdominal aorta (498 men and 420 women). A total of 24 abdominal aortic aneurysms were identified; 20 in men (4%) and four in women (0.9%). Of these, 11 were > 4 cm in transverse diameter. Following this study, only hypertensive men over the age of 60 years and women over the age of 65 years were screened from a total of 29 general practices. Regular scanning sessions were held at each practice and 1328 patients attended (744 men and 584 women). A total of 43 abdominal aortic aneurysms were detected; 39 in men (5.2%) and four in women (0.7%). Hypertensive men are at increased risk of developing abdominal aortic aneurysms and should be offered an initial ultrasound scan at 60 years of age. Female hypertensives yield a much lower detection rate and screening hypertensive females would probably be an inappropriate use of available resources.     

The value of screening in siblings of patients with abdominal aortic aneurysm.

OBJECTIVES: This study aimed to determine the incidence of abdominal aortic aneurysm (AAA) in a large group of siblings of Australian AAA patients to determine if screening in this group is justified. METHODS: 1254 siblings of 400 index AAA patients were identified and offered aortic ultrasound screening. An age and sex matched control group was recruited from patients having abdominal CT scans for non-vascular indications. AAA was defined by an infrarenal aortic diameter of > or =3 cm or a ratio of the infrarenal to suprarenal aortic diameter of > or =2.0. A ratio of 1.0-1.5 was considered normal, and a ratio of >1.5 to <2.0 was considered ectatic. Aortic enlargement was defined as ectasia or aneurysm. RESULTS: 276 (22%) siblings could be contacted and agreed to screening or had previously been diagnosed with AAA. All 118 controls had normal diameter aortas. 55/276 siblings had previously been diagnosed with AAA. The remaining 221 siblings underwent ultrasound screening. Overall, 30% (84/276) had enlarged aortas (5% ectasia, 25% aneurysmal); 43% of male siblings (64/150) and 16% of females siblings (20/126). The incidence was 45% in brothers of female index patients, 42% in brothers of male patients, 23% in sisters of female patients, and 14% in sisters of male index patients. CONCLUSIONS: The overall incidence of aortic enlargement of 30% found in this study warrants a targeted screening approach with ultrasound for all siblings of patients with AAA. A similar targeted approach for screening of the children of AAA patients would also seem advisable.     

Screening study of abdominal aortic aneurysm in a general population: lipid parameters

The level of blood lipids and apolipoproteins in subjects being screened for abdominal aortic aneurysms have been investigated. As part of an ultrasound screening programme in a population of 65- to 75-year-olds, blood samples were collected from 1460 of 1504 subjects with a normal aorta (97.1%) and 69 of 70 patients with an abdominal aortic aneurysm >29 mm (99%). Samples were also taken from 22 of 27 patients (81%) with an ectatic aorta (26–29 mm). Total cholesterol, HDL-cholesterol, LDL-cholesterol, Apo-AI and Apo-B levels were significantly higher in women than in men (P < 0.01). Levels of HDL-cholesterol and Apo-AI were significantly lower in patients with an abdominal aortic aneurysm than in normal subjects (P < 0.001). The mean (s.d.) body mass index was 25.1 (3.9) in women and 25.5(3.2) in men with aneurysms and not significantly greater than that of normal subjects (25.2(3.61) and 25.2(3.38) respectively). Copyright © 1996 The International Society for Cardiovascular Surgery.     

Prevalence of abdominal aortic aneurysms in urology patients referred for ultrasound

During a 3-year period, all urology patients over the age of 50 years referred for ultrasound investigation of the renal tract, underwent routine examination of the abdominal aorta. A total of 2281 patients were examined (1798 men and 483 women) and an abdominal aortic aneurysm was detected in 57 (2.5%). In men over the age of 65 years, 47 aneurysms were detected (4.9%). The mean time taken to scan the aorta was 43 s. We recommend the routine practice of examining the abdominal aorta in all men over the age of 60 years referred for ultrasound examination of the renal tract.     

The natural history of abdominal aortic aneurysms

This study examines the rate of expansion of abdominal aortic aneurysms and the risk of rupture in relation to their size. To assess these variables, we conducted a prospective study of 300 consecutive patients who presented over a 6-year interval with abdominal aortic aneurysms (AAA) that were initially managed nonoperatively. The mean age of the patients was 70.4 years, and 211 (70%) were men. The mean initial aneurysm diameter was 4.1 cm. Among the 208 patients who underwent more than one ultrasound or computed tomographic (CT) scan, the diameter of the aneurysm increased by a median of 0.3 cm per year. The 6-year cumulative incidence of rupture was 1% and 2% among patients with aneurysms less than 4.0 cm and 4.0 to 4.9 cm in diameter, respectively (p greater than 0.05). In comparison, the 6-year cumulative incidence of rupture was 20% among patients with aneurysms greater than 5.0 cm in diameter (p less than 0.004). We conclude that (1) abdominal aortic aneurysms expand at a median rate of 0.3 cm per year; and (2) the risk of rupture of abdominal aortic aneurysms less than 5.0 cm is substantially lower than the risk of rupture of aneurysms 5.0 cm or more in diameter.     

Fate of the ectatic infrarenal aorta: expansion rates and outcomes

The natural history of the ectatic infrarenal aorta remains undetermined. While surveillance protocols have been proposed for true aneurysms, no recommendations are currently available for ectatic aortas. The purpose of this study is to define the natural history and recommend surveillance protocols for the infrarenal aorta 2.5-2.9 cm in diameter. Screening of 12,500 yielded 223 patients with an infrarenal abdominal aorta 2.5-2.9 cm in diameter at a university-affiliated VA medical center. All patients were prospectively followed by ultrasound from August 1993 through October 2000 and expansion rates were calculated by comparing the first and last study. Multivariate analysis of risk factors classically associated with abdominal aortic aneurysm was performed. Current data suggest that ectatic infrarenal aortas expand slowly, do not rupture, and rarely meet criteria for operative repair. No risk factors linked to the development of aneurysms were identified. On the basis of this study we recommend that patients with ectatic aortas have a repeat ultrasound 5 years after the initial study.     

Ultrasonographic screening for abdominal aortic aneurysm.

OBJECTIVE--To assess the prevalence of abdominal aortic aneurysm in a selected group of men over the age of 60, and define main risk factors. DESIGN--Population based screening study. SETTING--Private Norwegian health maintenance organisation. SUBJECTS--500 men over the age of 60 years. INTERVENTIONS--General examination by a general practitioner, together with measurements of blood glucose and serum cholesterol concentrations. Abdominal scan with a B-mode ultrasound imager. MAIN OUTCOME MEASURES--An increase in the diameter of the aorta of more than 150% over the diameter at the origin of the superior mesenteric artery, or maximum diameter of more than 29 mm. Correlation with history of smoking, serum cholesterol concentration, and general health. RESULTS--29 patients (5.8%) had small, and 12 (2.4%) had large, abdominal aortic aneurysms. There was a significant association between aortic aneurysm and history of smoking (p < 0.01), poor health (defined as coexistent hypertension, cardiovascular disease, or diabetes mellitus) (p < 0.01), and increasing age (p = 0.025). There was no association with hypercholesterolaemia. CONCLUSION--Ultrasonic screening of groups at risk followed by elective operation may reduce mortality of abdominal aortic aneurysm.     

Is screening for abdominal aortic aneurysm bad for your health and well‐being?

BACKGROUND: The purpose of the present paper was to investigate whether screening for abdominal aortic aneurysm (AAA) causes health-related quality of life to change in men or their partners. METHODS: A cross-sectional case-control comparison was undertaken of men aged 65-83 years living in Perth, Western Australia, using questionnaires incorporating three validated instruments (Medical Outcomes Study Short Form-36, EuroQol EQ-5D and Hospital Anxiety and Depression Scale) as well as several independent questions about quality of life. The 2009 men who attended for ultrasound scans of the abdominal aorta completed a short prescreening questionnaire about their perception of their general health. Four hundred and ninety-eight men (157 with an AAA and 341 with a normal aorta) were sent two questionnaires for completion 12 months after screening, one for themselves and one for their partner, each being about the quality of life of the respondent. RESULTS: Men with an AAA were more limited in performing physical activities than those with a normal aorta (t-test of means P = 0.04). After screening, men with an AAA were significantly less likely to have current pain or discomfort than those with a normal aorta (multivariate odds ratio: 0.5; 95% confidence interval (CI): 0.3-0.9) and reported fewer visits to their doctor. The mean level of self-perceived general health increased for all men from before to after screening (from 63.4 to 65.4). CONCLUSIONS: Apart from physical functioning, screening was not associated with decreases in health and well-being. A high proportion of men rated their health over the year after screening as being either the same or improved, regardless of whether or not they were found to have an AAA.     

Variation of infrarenal aortic diameter: A necropsy study

PURPOSE: To determine anatomicomorphological changes in the infrarenal portion of the abdominal aorta, we performed 645 dissections of the segment in corpses undergoing necropsy. METHODS: The aortas were removed from the corpses with a surgical technique; by means of a device that we designed, the external diameter of the artery was measured after luminal pressure was reestablished. This way, it was possible to avoid underestimation of the arterial diameter postmortem. The influence of age, sex, body size, arterial hypertension, chronic obstructive pulmonary disease, and coronary disease on the aortic diameter and the influence of different degrees of sclerosis on the infrarenal aorta wall were analyzed. Considering the diameters, aortas were regarded as "normal" when they did not present any ectasia, arteriomegaly, aneurysm, or hypoplasia. RESULTS: The sample involved 645 subjects whose ages ranged from 19 to 97 years (mean age, 55.8 years). Of the 645 subjects, 65.5% (423) were men, 34.5% (222) were women, 81% (523) were white, and 19% (122) were of another race. The diameters of arteries showing no anomalous dilatation (ectasis, arteriomegaly, or aneurysm) varied according to subject age, sex, body length, and the degree of atherosclerosis on the aorta wall (P <.01). Aortic diameters of those subjects with arterial hypertension, coronary disease, and chronic obstructive pulmonary disease were compared with the aortic diameters of control subjects, and significant differences were not shown (P >.05). Twenty-nine aneurysms were found (4.5% prevalence). Four were ruptured aneurysms, and all occurred in aortas with diameters larger than 5.0 cm. CONCLUSION: The infrarenal aortic diameter enlarges with aging, and this enlargement occurs earlier in men than in women. Those subjects who had a longer body length and advanced sclerosis on the aorta wall had larger aortic diameters. There was a high prevalence of infrarenal aneurysms (4.5%), with rupture found solely in aortas with diameters larger than 5.0 cm.     

Ultraschallscreening auf abdominale Aortenaneurysmen (AAA)

Background

Abdominal aortic aneurysm (AAA) rupture is associated with a high mortality. The only preventive therapy is early diagnosis and elective surgery of rupture prone AAAs. Using B-mode sonography AAAs can be detected early with great reliability. Thus, a population-based ultrasound screening might lower the risk of abdominal aortic aneurysm ruptures.

Materials and methods

A literature analysis (until June 2014) was performed in the databases of MEDLINE, PubMed, and SCOPUS including all randomized controlled trials (RCT), systematic reviews, meta-analyses, health technology assessments (HTA reports) and medical guidelines on AAA screening. The following keywords were used: abdominal aortic aneurysm, ultrasound screening, evidence, guidelines. Clinically relevant endpoints were the following: AAA-associated mortality, overall mortality, number of elective AAA operations, number of ruptured AAAs and emergency surgery for different follow-up intervals.

Results

In four RCTs men between 65 and 83 years either had a single or no ultrasound examination of the abdominal aorta. Older women were only analyzed in one RCT. The meta-analysis of the RCT results shows that ultrasound screening caused a significant decrease of AAA-associated mortality, number of ruptured abdominal aneurysms, and number of emergency operations, whereas the number of elective surgeries significantly increased. Overall mortality was only moderately decreased by AAA screening.

Conclusion

Evidence was provided in population-based RCTs and meta-analyses for the efficiency of ultrasound based AAA screening for men older than 65 years. Presently the Federal Joint Committee (G-BA) and the Institute for Quality and Efficiency in Health Care (IQWIG) are evaluating a national ultrasound-based AAA screening program for Germany. However, additional clinical trials are necessary to assess risk groups especially men under 65 years, women with nicotine abuse and cardiovascular diseases which were underrepresented in previous studies.     

Screening of abdominal aortic aneurysm: a pragmatic approach

In order to evaluate the feasibility of a selective screening programme for abdominal aortic aneurysm (AAA) within an urban setting and assess its impact on the expected increase in workload for the local hospital(s), a population based, prospective study was performed. A total of 4823 men aged 65 years were invited for ultrasound examination of the abdominal aorta between January 1993 and April 1997 as part of a general practice-based aneurysm screening programme covering two districts with a general hospital each. All examinations were carried out by senior radiographers using a portable B mode grey scale machine and a 3.5 MHz curvi-linear array probe. Patients with a maximum aortic diameter of over 3 cm were annually recalled, those with over 4 cm were referred to hospital for an out-patient's appointment. Those with AAA greater than 5 cm were considered for surgery. Of those approached, 3497 (72.5%) took part in the study, 1206 (25%) did not attend and 120 (2.5%) were excluded by their general practitioners (GPs) on medical grounds. Of the men taking part, 3130 (89.5%) had an aortic diameter equal to or less than 2.5 cm, 196 (5.6%) between 2.6 and 3.0 cm, and 171 (4.9%) had aortic diameters greater than 3 cm--29 of whom had AAA greater than 5 cm with a mean diameter of 6.0 cm (range 5.1-9.0 cm). Of 127 men with an initial diameter of 3.1-4.0 cm (mean progression in size of 2.3 mm/year), 22 enlarged to > 4 cm and 3 to > 5 cm. Of 24 men with an initial diameter of 4.1-5.0 cm, 6 enlarged to > 5 cm. Some 69 (2%) patients were referred to hospital requiring a total of 125 consultations (1.8 consultations per patient); 21 underwent surgery and one died from rupture whilst awaiting surgery. Five patients refused their operation and two failed to attend the clinic (all > 5 cm) but remain well to date. No patient died following surgery. We conclude that, screening for AAA in men at age 65 years within an urban setting is feasible and well received by patients and GPs. Screening does not lead to a huge increase in terms of outpatient appointments and operations for AAA.     

Abdominal aortic dilatation in patients operated on for carotid artery stenosis

The prevalence of abdominal aortic dilatation among 201 men and 86 women who underwent carotid endarterectomy in 1971-1982 was studied from the date of operation to the end of 1984. Of the 109 patients who died during this time, 96 were autopsied, and 13 (13.5%) of them had aneurysm of the abdominal aorta. Ultrasonographic screening of the abdominal aorta was performed on 154 survivors, and showed dilatation in 17 (11%), 12/100 men and 5/54 women. The prevalence of hypertension, intermittent claudication, diabetes mellitus and coronary insufficiency at the time of endarterectomy did not differ between the patients with or without aortic aneurysm or dilatation. Patients who have undergone endarterectomy of the internal carotid artery constitute a group with high prevalence of abdominal aortic dilatation.