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June 2, 1999

Diagnosing Abdominal Aortic Aneurysm

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor


Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999

JAMA. 1999;281(21):1989. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-21-jbk0602

To the Editor: The article by Drs Lederle and Simel1 brings to the clinician's attention the serious nature of abdominal aortic aneurysms (AAAs). While the article will serve as a valuable reference for clinicians, their last sentence must be disputed. When a ruptured AAA is suspected, imaging studies such as ultrasonography or computed tomography should not be performed. When a patient presents to the emergency department or a physician's office with hypotension, a pulsatile abdominal mass, and associated flank or abdominal pain, the patient should be taken directly to the operating room for exploration and repair of a ruptured AAA. Delaying operation with imaging studies only allows the patient's condition to become more unstable. Patients may die as a result of delay while awaiting preoperative studies. It has always been my contention that more patients will die of an AAA on the table of a computed tomography scanner than will die on the operating table. It is better to treat a nonruptured aneurysm as an emergency than to treat a ruptured aneurysm electively.

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