Bayerbches h d e s a m tRetrospective analysis of 545 surgical patients with infrarenal abdominal aortic aneurysm (AAA) identified 5.1 per cent with unilateral lower-limb amputation'. A pathogenic role for the asymmetrical distal aortic flow and counter pulse wave after amputation has been suggested as a cause of aneurysm. A cross-sectional study reported a greater than fivefold increased risk of AAA after unilateral above-knee amputation'. However, the prevalence of aortic aneurysm was rather low in the reference grou of this study compared with that in other p~b1ications~'~and atherosclerotic risk factors were not strictly controlled. A prospective study was therefore carried out on amputees and concurrent controls to clarify the prevalence of AAA, to challenge the local haemdynamic hypothesis of aneurysm formation and to estimate the contribution of atherosclerotic risk factors. Patients and methodsFrom May 1990 to December 1991 all consecutive veterans with lower-limb amputation and a random sample of controls of similar age without amputation presenting to the authors' institutions were studied. A standardized history, physical examination, electrocardiogram, biplanar lumbar radiograph and fasting levels of glucose and lipids wep obtained. The abdominal aorta and iliac arteries were visualized in continuous orthogonal planes by experienced sonographers using a Toshiba VA 100s ultrasonographic scanner (Toshiba. Tokyo, Japan). Aneurysmal dilatation was defined as a maximal luminal diameter greater than 30mm or localized dilatation of the infrared aorta of more than 50 per cent'.Group differences were analysed by Student's t test, the Wilcoxon rank sum test or the x2 test as appropriate. A sample size of 153 was estimated as required to detect a tripling of the estimated 5 per cent prevalence of aneurysm with a power of 90 per cent.
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