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PATRIZIO CASTELLI

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.

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PATRIZIO CASTELLI

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  1. 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

  2. Holt PJE, et al. Provider volume and long-termoutcomeafterelectiveabdominalaorticaneurysmrepair. • Br J Surg2012;99:666-672 • Barshes NR, et al. Increasingcomplexity in the open surgicalrepairofabdominalaorticaneurysms. • AnnVascSurg2012;26:10-17 • Chadi SA, et al. Trend in management ofabdominalaorticaneurysms • J VascSurg2012;55:924-928 • Grant SW, et al. Evaluationoffiveriskpredictionmodelsforelectiveabdominalaorticaneurysmrepairusing the UK National Vascular database • Br J Surg2012;99:673-679 • McPhee JT, et al. Surgeon case volume, notinstitution case volume, is the primarydeterminantofin-hospitalmortalityafterelective open abdominal • aorticaneurysmrepair. • J VascSurg2011;53:591-599 • Brown LC, et al. Useofbaselinefactorstopredictcomplications and reinterventions afterendovascularrepairofabdominalaorticaneurysm. • Br J Surg2010;97:1207-1217 • Landon BE, et al. Volume-outcomerelationship and abdominalaorticaneurysmrepair. • Circulation2010;122:1290-1297 • Schanzer A, et al. Vascularsurgery training trendsrfom 2001-2007: a substantialincrease in total procedure volume isdrivenbyescalatingendovascular • procedure volume and stable open procedure volume. • J VascSurg2009;49:1339-1344 • Hill JS, et al. Regionalizationofabdominalaorticaneurysmrepair: evidenceof a shifttohigh-volumecenters in the endovascular era. • J VascSurg2008;48:29-36 • Dimick JB, et al. Surgeonspecialty and provider volumes are relatedtooutcomeofintactaabdominalaorticaneurysmrepair in the UnitedStates. • J VascSurg2003;38:739-744

  3. SOTTORENALE IUXTARENALE PSEUDO P.A.U. DISSECANTE

  4. PREVALENZA • DIAGNOSI di A.A.A. • TRATTAMENTO di A.A.A. ROTTI INTATTI

  5. “SHIFT OF THE PARADIGM”

  6.  CASI EVAR •  CASI ASA IV •  CASI 80enni

  7. SOPRAVVIVENZA • SOVRAPPONIBILE > 2y • COMPLICANZE: TASSO PIU’ • ELEVATO @ 30g-6m

  8. DEFINIZIONE VOLUME DELL’OSPEDALE (“PROVIDER”) DEL CHIRURGO RIFERIMENTO CONDIVISO: > 30 CASI/y

  9. 59.7% 40.3%

  10. MORTALITA’ HVH SUPERIORITA’ ESTESA AD OLTRE 2 ANNI NONOSTANTE “HIGH RISK” STRETTAMENTE CORRELATA A MORTALITA’ @ 30d “SECONDARY MANAGEMENT”

  11. HVH HANNO ADOTTATO EVAR • RAPIDAMENTE E CON MAGGIOR • ESTENSIVITA’ DI CASI

  12. PIU’ FREQUENTEMENTE • NEL CONTESTO DIHVH • MA SOLO 27% DEGLI A.A.A. • TRATTATI DA CH VASCOLARI • PIU’ FREQUENTEMENTE • SONO HVS • rA.A.A. PIU’ FREQUENTEMENTE • OPERATI DA GENERALI

  13. MORTALITA’ A.A.A. • DETERMINATA DA “EFFETTO ADDITIVO”: VOLUME ANNUALE DI CHIRURGO E HOSP DISCIPLINA DI SPECIALIZZAZIONE

  14. HIGH VOLUME HOSPITAL (A.A.A.) TEACH 44.6% N-TEACH 12.6% URBAN 29.2% RURAL 3.4% EVAR 62.9% 34.2%

  15.  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)

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