Diagnosing Abdominal Aortic Aneurysm

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.