The Evaluation of the Abdominal Aorta: A “How-to” for Cardiac Sonographers

Routine Screening for Abdominal Aortic Aneurysm in the Echocardiography Laboratory Using a “Modified” Abdominal Aortic Examination Protocol

“…The transducer should follow both iliac vessels longitudinally, as an AAA may extend into these vessels. 9 Short-axis aortic plane images should next be obtained, with the transducer index mark pointing toward the patient's left side. Imaging begins in the subcostal window, and proceeds caudally, with images obtained every 1-2 cm.…”

“…Outside-to-outside wall measures, however, best correlate with surgical findings. 9 Diagnostic quality image yield has been reported from echocardiography laboratories to be in the range of 86% 3 -95%, 2 despite no special abdominal preparation before examinations were performed. The false-negative rate is difficult to calculate as most patients do not undergo further testing for AAA.…”

“…Measurement of aortic diameter is performed from the longitudinal plane (anteroposterior dimension) and the transverse plane (anteroposterior and lateral dimensions), most often using a leading‐edge‐to‐leading‐edge, 2 or inner‐edge‐to‐inner‐edge 1 method. Outside‐to‐outside wall measures, however, best correlate with surgical findings 9 …”

“…Most reported studies from laboratories whose primary function is TTE, perform a “modified” abdominal aortic examination (MAE), 1–3 to quickly screen for an AAA; however, a more complete examination is performed by others 9 . An MAE is generally performed with a low‐frequency cardiac sector transducer, during the subcostal part of the TTE study.…”

“…Imaging first begins from a subcostal position and continues toward the umbilical area, which is usually the level of the aortic bifurcation. The transducer should follow both iliac vessels longitudinally, as an AAA may extend into these vessels 9 . Short‐axis aortic plane images should next be obtained, with the transducer index mark pointing toward the patient's left side.…”