L’ ANEURISMA AORTICO
ADDOMINALE
PATRIZIO CASTELLI
CHIRURGIA VASCOLARE
DIPARTIMENTO DI SCIENZE CHIRURGICHE E MORFOLOGICHE
UNIVERSITA’ DEGLI STUDI DELL’INSUBRIA
A.O.U. OSPEDALE DI CIRCOLO E “FONDAZIONE MACCHI” - VARESE
• Holt PJE, et al. Provider volume and long-term outcome after elective abdominal aortic aneurysm repair.
Br J Surg 2012;99:666-672
• Barshes NR, et al. Increasing complexity in the open surgical repair of abdominal aortic aneurysms.
Ann Vasc Surg 2012;26:10-17
• Chadi SA, et al. Trend in management of abdominal aortic aneurysms
J Vasc Surg 2012;55:924-928
• Grant SW, et al. Evaluation of five risk prediction models for elective abdominal aortic aneurysm repair using the UK National Vascular database
Br J Surg 2012;99:673-679
• McPhee JT, et al. Surgeon case volume, not institution case volume, is the primary determinant of in-hospital mortality after elective open abdominal
aortic aneurysm repair.
J Vasc Surg 2011;53:591-599
• Brown LC, et al. Use of baseline factors to predict complications and reinterventions after endovascular repair of abdominal aortic aneurysm.
Br J Surg 2010;97:1207-1217
• Landon BE, et al. Volume-outcome relationship and abdominal aortic aneurysm repair.
Circulation 2010;122:1290-1297
• Schanzer A, et al. Vascular surgery training trends rfom 2001-2007: a substantial increase in total procedure volume is driven by escalating endovascular
procedure volume and stable open procedure volume.
J Vasc Surg 2009;49:1339-1344
• Hill JS, et al. Regionalization of abdominal aortic aneurysm repair: evidence of a shift to high-volume centers in the endovascular era.
J Vasc Surg 2008;48:29-36
•Dimick JB, et al. Surgeon specialty and provider volumes are related to outcome of intact aabdominal aortic aneurysm repair in the United States.
J Vasc Surg 2003;38:739-744
SOTTORENALE
IUXTARENALE
PSEUDO
P.A.U.
DISSECANTE
• PREVALENZA
ROTTI
DIAGNOSI di A.A.A.
TRATTAMENTO di A.A.A.
INTATTI
“SHIFT OF THE PARADIGM”
•  CASI EVAR
•  CASI ASA IV
•  CASI 80enni
• SOPRAVVIVENZA
SOVRAPPONIBILE > 2y
• COMPLICANZE: TASSO PIU’
ELEVATO @ 30g-6m
•
•
• DEFINIZIONE VOLUME
DELL’OSPEDALE (“PROVIDER”)
DEL CHIRURGO
RIFERIMENTO CONDIVISO:
> 30 CASI/y
59.7%
40.3%
• MORTALITA’ HVH
SUPERIORITA’ ESTESA
AD OLTRE 2 ANNI
NONOSTANTE
“HIGH RISK”
STRETTAMENTE CORRELATA
A MORTALITA’ @ 30d
“SECONDARY MANAGEMENT”
• HVH HANNO ADOTTATO EVAR
RAPIDAMENTE E CON MAGGIOR
ESTENSIVITA’ DI CASI
• PIU’ FREQUENTEMENTE
NEL CONTESTO DI HVH
• MA SOLO 27% DEGLI A.A.A.
TRATTATI DA CH VASCOLARI
• PIU’ FREQUENTEMENTE
SONO HVS
• rA.A.A. PIU’ FREQUENTEMENTE
OPERATI DA GENERALI
• MORTALITA’ A.A.A.
DETERMINATA DA
“EFFETTO ADDITIVO”:
VOLUME ANNUALE
DI CHIRURGO E HOSP
DISCIPLINA DI
SPECIALIZZAZIONE
TEACH
44.6%
N-TEACH
12.6%
EVAR
62.9%
34.2%
URBAN RURAL
29.2% 3.4%
•  NUM DEI CLAMP
SOVRARENALE (14.1% vs 30.3%)
•  COMPLICANZE PER CLAMP
SOVRARENALE (25.8% vs 31.9%)
• CLAMP SOVRARENALE
 SOPRAVVIVENZA, @5-10y
(P = .04)