Pulse characteristics of abdominal aortic aneurysm and of the femoral artery distal to it.

The advent of successful surgical treatment of abdominal aneurysm has increased the importance of detection and diagnosis of these lesions. The author has studied the pulse characteristics of abdominal aortic aneurysm and the distal femoral artery, and reports his results. ANEURYSM of the abdominal aorta is of ,AA current interest because of its apparent increasing incidence, now occurring in at least 1.5 per cent of autopsies' and its successful surgical management, which according to Wright2 was first reported by Dubost in 1951. The diagnosis depends on the presence of abdominal or back pain, on palpation of a pul-satile abdominal mass with or without tenderness , with or without a bruit, on x-ray evidence of a soft-tissue mass or calcification in the wall of the aneurysm, or, finally, on aor-tography. The width of the aneurysm as determined by palpation or x-ray is of prog-nostic significance, since only 4 to 18 per cent of aneurysms under 6 to 7 em. in width found at autopsy have ruptured, as compared to 72 to 82 per cent of those over 6 to 7 cm.3' 4 At present, the diagnosis of small aortic aneu-rysms is unsatisfactory, especially in obese patients. There have been many references in the older literature to the effect of an aneurysm on the pulse distal to it. 1135 it was a general postulate that aortic aneu-rysms reduce the amplitude of propagated pulses. Valleix, Weber, and Marey,5 in addition , believed that an aneurysm produced a delay in the presentation of the distal pulse. Marey5 constructed an artificial system whereby he transmitted a pulsation through a channel containing an aneurysmal pouch and recorded a pulsation of less amplitude and delayed peak force than when the same pulsation was transmitted through a serial channel of normal size. He compared these tracings with those of patients with subelavian aneu-rysms, which showed the same decreased amplitude and delayed peak in the radial pulse on the side below the aneurysm. He concluded that an aortic aneurysm would have these same qualitative changes, though to a lesser degree, because of its smaller size in relation to the size of the vessel. Whittlesey found" in constructing an artificial saccular aneu-rysm of the aorta that a volume of 400 ml., which doubled the capacity of the system, was required to decrease the peripheral pulse below the central pulse. Wright,2 referring specifically to pulses below abdominal aortic aneurysm, found a …