Discordance in the sizing of abdominal aortic aneurysm and its significance.

Much of the confusion surrounding the repair of asymptomatic abdominal aortic aneurysms related to inaccuracies in their measurement, both preoperatively and intraoperatively. Multiple measurements of aneurysms at operation have convinced us that the largest and least variable diameter is the anteroposterior diameter measured from aortic wall anteriorly to vertebral bodies posteriorly. This AP-to-spine distance is accurately predicted by ultrasonography to within 0.3 cm. Computerized tomography does no better. plain radiography is accurate but seldom applicable. When properly estimated, aneurysm size can be accurately determined preoperatively by either ultrasonography, computerized tomography, or plain radiography, in that order of preference. Since the decision to operate on asymptomatic aneurysms is based largely on their size, accurate preoperative estimation is essential.