Objective-To assess the relationship between infrarenal aortic diameter and subsequent all-cause mortality in men aged 65 years or older. Methods and Results-Aortic diameter was measured using ultrasound in 12 203 men aged 65 to 83 years as part of a trial of screening for abdominal aortic aneurysms. A range of cardiovascular risk factors was also documented. Mortality over the next 3 to 7 years was assessed using record linkage. Initial aortic diameter was categorized into 10 intervals, and the relationship between increasing diameter and subsequent mortality was explored using Cox proportional hazard models. Median diameter increased from 21.4 mm in the youngest men to 22.1 mm in the oldest men. The cumulative all-cause mortality increased in a graded fashion with increasing aortic diameter. Using the diameter interval 19 to 22 mm as the reference, the adjusted hazard ratio for all-cause mortality increased from 1. [3][4][5] In other words, not only is an AAA a potentially dangerous condition in its own right but also is it a marker for death from other causes. This appears to be primarily caused by an association with various manifestations of cardiovascular disease. 4,5 The distribution of infrarenal aortic diameter is continuous, albeit skewed to the right, and as such the choice of the 30 mm threshold is arbitrary. 6,7 No attention has been given to the possibility that there may be a continuous relationship between infrarenal aortic diameter in the nonaneurysmal range (Ͻ30 mm in diameter) and all-cause mortality. We have used data collected as part of the Western Australian trial of screening for AAA 8 to test the hypothesis that infrarenal aortic diameter predicts all-cause mortality in a cohort of 12 203 men aged 65 years and older. Methods Subject Recruitment and ScreeningDetails of the trial of screening are described elsewhere. 8 Eligible men were identified and recruited from an electronic copy of the electoral roll, enrollment to vote being compulsory for Australian citizens, and invited to attend a screening clinic close to their home. Women were not invited for screening because their prevalence of AAA is one-sixth that in men. 9 On arrival at the clinic, the study was explained to each participant and written consent was obtained. Each man completed a questionnaire about demographic factors, medical and occupational history, and aspects of diet and lifestyle relevant to cardiovascular disease. This was followed-up by a brief physical examination (height, weight, girth at hips and waist, blood pressure) by a nurse and then measurement of the maximum transverse and antero-posterior diameter of the infrarenal aorta using a Toshiba Capasee ultrasound machine with a 3.75 mol/L Hz probe (Toshiba Australia). The largest measurement was recorded as the aortic diameter, with images recorded on videotape for later verification by a radiologist if required. All 4 staff members performing ultrasound examinations participated in regular quality-control exercises in which interrater and intrarater agreement ...

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Objective: To assess the influence of probe position, lipodermatosclerosis and method of calf muscle emptying on the venous refilling time as measured by photoplethysmography in both normal limbs and limbs with chronic venous disease. Design: Prospective evaluation of age- and sex-matched control and study groups. Setting: University Department of Surgery, Vascular Research Laboratory, Fremantle Hospital, Western Australia. Patients: There were 38 controls and 31 patients with venous ulceration. Interventions: Venous refilling times were measured in six positions on the leg in all subjects: the foot, 5 cm below medial tibial condyle in the upper calf, and in the gaiter region on the medial, lateral, anterior and posterior positions at 7.5 cm above the medial malleolus. Measurements were undertaken on active exercise and after bimanual calf compression in the medial gaiter region. Measurements were also undertaken in areas of lipodermatosclerotic skin and in normal-appearing adjacent skin. Results: In normal legs, the lowest refilling times were in the anterior and lateral gaiter positions. Venous patients had a shorter refilling time in the dorsal foot, medial gaiter, posterior gaiter and medial below-knee positions, when compared with controls (Mann–Whitney U-test, p<0.01). The shortest refilling time in patients with venous disease was in the medial gaiter region. Refilling time was slightly prolonged over Hpodermatosclerotic skin compared with adjacent normal-looking skin. Refilling time measured after passive emptying of the calf muscle by external compression was significantly prolonged compared with calf emptying by active calf compression ( p<0.01). This change was similar for both groups. Conclusions: When using venous refilling time on photoplethysmography to distinguish venous from normal limbs, the best separation is in the medial gaiter position. If other probe sites or methods of calf emptying are to be employed, it is imperative that individual laboratory normal ranges be established for the particular method being employed.