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Palpate for abdominal aortic aneurysm in all CV patients: often missed.

SNOWMASS, COLO. -- Make palpation of the abdominal aorta a routine part of the evaluation of every patient who presents with any sort of cardiovascular condition, Dr. Jeffrey W. Olin urged at a conference sponsored by the American College of Cardiology.

Why? Because roughly 40% of patients who die of a ruptured abdominal aortic aneurysm will have seen a physician within the preceding 6 months.

This indicates that large numbers of affected patients aren't being examined for this entity, said Dr. Olin, professor of medicine and director of vascular medicine at Mt. Sinai School of Medicine, New York.

He recalled the dramatic example of a patient referred to him by a cardiologist for claudication after the patient's primary care physician had first referred him to the cardiologist for the same problem.

"When I walked into the examining room I saw a pulsatile abdominal mass. This patient had a 10-cm abdominal aortic aneurysm that had gone unrecognized," the cardiologist recalled.

Twenty percent of patients who have an abdominal aortic aneurysm also have a popliteal artery aneurysm. The natural histories of the two conditions are very different.

The most common complication of abdominal aortic aneurysm is rupture, following by emboli and thrombosis. In contrast, thrombosis is the number one complication of popliteal artery aneurysm.

Popliteal artery aneurysm results in acute limb ischemia. If the lesion goes unrecognized and thrombosis occurs, about 50% of patients end up undergoing amputation.

Treatment of a thrombosed popliteal artery aneurysm entails thrombolytic therapy directed by arterial catheter, followed by surgical bypass or an endovascular stent graft.

BRUCE JANCIN

Denver Bureau
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Title Annotation:Cardiovascular Medicine; cardiovascular
Author:Jancin, Bruce
Publication:Internal Medicine News
Article Type:Brief Article
Date:Jul 15, 2003
Words:262
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