To the Editor.—4In their assessment of the utility of selective screening for abdominal aortic aneurysms (AAA), Lederle et al1 have presented a case for selective AAA screening by drawing tenuous support from referral center—based studies of AAA prognosis.
First, the authors cite a referral center study arguing that "following successful surgery, the survival rate approaches that of the general population." It seems unlikely that patients with an arteriosclerotic process such as AAA, which is linked to other processes associated with impaired survival such as hypertension and coronary artery disease, will have a survival following aneurysmectomy similar to that of the general population. In this regard, of the 131 Olmsted County, Minnesota, residents who underwent elective aneurysmectomy in the 1971-1987 time period, 5-year survival was only 61% (expected survival for 1980 Minnesota whites of the same age and gender distribution was 79%) and 10-year survival was 24% (expected,
BALLARD DJ. Selective Screening for Abdominal Aortic Aneurysms With Physical Examination and Ultrasound. Arch Intern Med. 1989;149(6):1463–1466. doi:10.1001/archinte.1989.00390060167045
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