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Anévrisme aorte abdominale (AAA) Consensus canadien - ACC/AHA - SSVQ - 2006

Anévrisme aorte abdominale (AAA) Consensus canadien - ACC/AHA - SSVQ - 2006. Définition et histoire naturelle Dépistage Interventions. André Roussin MD, FRCP Laboratoire de médecine vasculaire, Hôpital Notre-Dame, CHUM Professeur adjoint, Université de Montréal. .org.

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Anévrisme aorte abdominale (AAA) Consensus canadien - ACC/AHA - SSVQ - 2006

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  1. Anévrisme aorte abdominale (AAA)Consensus canadien - ACC/AHA - SSVQ - 2006 • Définition et histoire naturelle • Dépistage • Interventions André Roussin MD, FRCP Laboratoire de médecine vasculaire, Hôpital Notre-Dame, CHUM Professeur adjoint, Université de Montréal .org Can J Cardiol 2005; 21(12): 997-1006 www.ccs.ca

  2. Disclosures - DivulgationsAndré Roussin MD Speaker and/or Advisory board member and/or Research funds • AstraZeneca • Bristol Myers Squibb • Merck Frost Schering • Pfizer Canada Inc. • sanofi aventis

  3. AAADéfinition et prévalence AAA : Diamètre > 3 cm (AP en général) ACC/AHA 2005

  4. AAAExamen physique: sensibilité pour le dépistage • Sensibilité globale: 68% • 61% si diam. 3.0 - 3.9 cm • 69% si diam. 4.0 - 4.9 cm • 82% si diam > 5.0 cm • 91% si TT < 100 cm • 53% si TT > 100 cm • 100% si diam > 5.0 cm et TT < 100 cm Fink H A et al. Arch Int Med 2000; 160: 833 - 836

  5. AAA et anévrismes des extrémitésHistoire naturelle générale • AAA: rarement • Thromboembolie • Compression ou érosion de structures adjacentes • Anévrismes extrémités • Thromboembolie • Thrombose • AAA : principalement • Expansion • < 4mm/an • Si < 4 cm • 4 - 5 mm/an • Si 4 - 6 cm • Rupture

  6. AAA ≥ 5.5 cmRisque de rupture: US VA Study Consensus canadien MAP CCS 2005

  7. AAA en fonction du sexeRisque de rupture: série de Kingston, Ontario Consensus canadien MAP CCS 2005

  8. AAA : petits vs grosRisque de rupture: UK Small Aneurysm Trial 1999 ACC/AHA PAD Consensus 2005

  9. AAA : perspective globaleRisque de rupture: ACC/AHA 2005 ACC/AHA PAD Consensus 2005

  10. Anévrismes viscéraux2 - 3 X moins fréquents que AAA

  11. AAADépistage: Consensus américain 2004 Abdominal aortic aneurysm can easily be missed, especially in obese patients, so that echography is the preferred method of diagnosis in high-risk patients, such as men aged 60 to 85 years, women aged 60 to 85 years with cardiovascular risk factors and men and women older than 50 years with a family history of AAA Kent KC. Screening for abdominal aortic aneurysm: A consensus statement. J Vasc Surg 2004; 39: 267-269

  12. AAADépistage : USPTF 2005 The USPSTF found good evidence that screening for AAA and surgical repair of large AAAs ( 5.5 cm) in men age 65 to 75 years who have ever smoked (current and former smokers) leads to decreased AAA-specific mortality. There is good evidence that abdominal ultrasonography, performed in asetting with adequate quality assurance (…), is an accurate screening test for AAA. Ann Intern Med. 2005; 142:198-202.

  13. AAASuivi et Intervention > 1 cm/an* * CCS 2005 Sakalihasan N et al. Lancet 2005; 365: 1577-89

  14. Canadian Cardiovascular Society Consensus Conference 2005Peripheral Arterial Disease Beth ABRAMSON, Toronto Sonia ANAND, Hamilton Tom FORBES, London Anil GUPTA ,Brampton Ken HARRIS, London Vic HUCKELL, Vancouver Asad JUNAID, Winnipeg Tom LINDSAY, Toronto Finlay McALISTER, Edmonton Andre ROUSSIN, Montreal Jacqueline SAW, Vancouver Koon TEO, Hamilton A. G TURPIE, Hamilton Subodh VERMA, Toronto

  15. Recommendations CCS 2005Aneurysm Screening Tom Lindsay

  16. Recommendations CCS 2005AAA Follow-up Based on Initial Size Tom Lindsay

  17. AAATraitement médical • Traitement des facteurs de risque • Tabagisme surtout • B-Bloqueurs pour les AAA > 5 cm ? • Inefficaces pour AAA < 5 cm • Marfan: diminution des complications Ao. • IECA ? (selon observation de cohorte) • Réduction risque rupture: RRR ajusté 0.83 • Pas d’effet par autres Tx HTA y compris BRA • Bloqueurs JNK et/ou MMP 2 - 8 - 9

  18. AAALe rôle de JNK et des MMP Verma S, Lindsay T. NEJM 2006; 354: 2067-8

  19. AAALe rôle de JNK et des MMP Verma S, Lindsay T. NEJM 2006; 354: 2067-8

  20. Sources d'information ACC/AHA 2005 guidelines on PAD www.acc.org www.americanheart.org .org Consensus canadien 2005 MAP Can J Cardiol 2005; 21(12): 997-1006 www.ccs.ca

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