" aaa wanted " 2012 s paulo vascular surgery meeting

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AAA WANTED prevention of ruptured abdominal aortic aneurysm: a project to prevent sudden death April 13-14, 2012 DIVISION OF VASCULAR AND ENDOVASCULAR SURGERY Chief: Salvatore Ronsivalle, MD

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Page 1: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

AAA WANTED

prevention of ruptured abdominal aortic aneurysm:

a project to prevent sudden death

April 13-14, 2012

DIVISION OF VASCULAR AND ENDOVASCULAR SURGERY

Chief: Salvatore Ronsivalle, MD

Page 2: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting
Page 3: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

S.Pauloarea 1523 kmq

19.000.000 residents

VenetoArea 18.400.000 kmq4.900.000 residents

population 250.326 residentsArea 582 Kmq;density 429,87 residents / Kmq

Page 4: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

BACKGROUND

AAA: asymptomatic disease but its rupture is a surgical

emergency and often leads to death

Early diagnosis is very important for an optimal management

and for planning surgery in a short time

Literature provides evidence in favor of screening

Page 5: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

AAA PREVALENCE FOR SEX AND AGE

1,3

0,0

12,5

5,2

0,0

1,0

2,0

3,0

4,0

5,0

6,0

7,0

8,0

9,0

10,0

45-54 years 75-84 years

male

female

Page 6: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

PROJECT AIMS

★ MAIN : prevention of death due to ruptured

abdominal aortic aneurysm by treating the asymptomatic pathology

through identification, monitoring and early planned surgery

★ SECONDARY : observation and study of risk

factors distribution in normal and affected population

Page 7: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

MATERIALS AND METHODS

★ FREE MEDICAL EXAMINATION

★ Project that lasts 7 years

★ Each year we call all people who will turn 68 or 74 on their next birthday

★ In four years 17868 people were invited and we performed 11426 aorto–iliac district CDU with an average of 63.5%

★ shuttle bus service is organized for people who lived outside the city

Page 8: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

ORGANIZATION

★ ELECTRONIC SUPPORT: DATA BASE to collect and store data

★ SECRETARY ORGANIZATION: sending out invitations, shuttle bus

service organization, information, appointment scheduling

★ STAFF: 4 doctors, 2 nurses, 2 orderlies

★ SERVICE HOURS: 4 laboratories open from Monday to Friday

(14.30-16.30)

Page 9: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

DEPARTMENT ORGANIZATION

CARDIOVASCULAR DEPARTMENTCARDIOVASCULAR DEPARTMENT

CITTADELLACITTADELLA

CARDIOLOGY DIVISION

CARDIOLOGY DIVISION

CAMPOSAMPIEROCAMPOSAMPIERO

INTERVENTIONALCARDIOLOGY

UNIT

INTERVENTIONALCARDIOLOGY

UNIT

VASCULARSURGERY

DIVISION

VASCULARSURGERYDIVISION

ANGIOLOGYUNIT

ANGIOLOGYUNIT

CARDIOLOGY DIVISION

CARDIOLOGY DIVISION

ELECTROPHYSIOLOGY

UNIT

ELECTROPHYSIOLOGY

UNIT

Page 10: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

5 SURGEONS5 SURGEONS

ANGIOLOGYUNIT

ANGIOLOGYUNIT

OPERATING ROOMDAY SURGERYAMBULATORY

OPERATING ROOMDAY SURGERYAMBULATORY

VASCULAR-ENDOVASCULAR SURGERY AND ANGIOLOGY

VASCULAR ANDENDOVASCULAR SURGERY

DEPARTMENT

VASCULAR ANDENDOVASCULAR SURGERY

DEPARTMENT

WARDWARD

3 INTERNISTS3 INTERNISTS

ANGIOLOGY NON INVASIVE DIAGNOSTIC

DAY HOSPITAL

ANGIOLOGY NON INVASIVE DIAGNOSTIC

DAY HOSPITAL

CARDIOVASCULAR DEPARTMENTCARDIOVASCULAR DEPARTMENT

Page 11: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

QUESTIONNAIRE FOR PRINCIPAL VASCULAR RISK FACTORS

Heart disease

Obesity

Hypercholesterolemia

Diabetes

Smoke

High blood pressure

Familiarity for abdominal aortic aneurysm

Previous cardiovascular surgery

Page 12: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

Aorta < 30 mmIliac < 15 mm

Aorta < 30 mmIliac < 15 mm

Aorta 30-45 mmIliac 15-25 mm

Aorta 30-45 mmIliac 15-25 mm

Aorta > 45 mmIliac > 25 mm

Aorta > 45 mmIliac > 25 mm

check up

check up

Annual follow up Annual

follow up

Further examination

Further examination

check upcheck up

check upcheck up

Surgery Surgery

Aorto-iliacCDU

Aorto-iliacCDU

AORTO ILIAC DISTRICT CDU

Page 13: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

PUBLIC HEALTH SERVICE AREA

Total population at 31.12.2008: 250.326 residentsArea: 582 Kmq; density 429,87 residents / Kmq

20 km

34 km

28 km12 km

24 km27 km

Page 14: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

61

,3

66

,7 62

,5

61

,9

62

,3

70

,6 65

,4

66

,9 66

,9

69

,8

68

,2

68

,0

55

,3 52

,4

66

,0

56

,9

68

,9

59

,7

67

,2

68

,1

68

,7

72

,3

59

,2

58

,0

61

,8

69

,3 60

,0

63

,0

0

10

20

30

40

50

60

70

80

90

100

Borgoricco

C.S

.Martino

Cam

podarsego

Cam

podoro

Cam

posampiero

Carm

ignano

Cittadella

Curtarolo

Fontaniva

Galliera

Gazzo

Grantorto

Loreggia

Massanzago

Piazzola

Piom

bino

S.G

.Pertiche

S.G

.Bosco

S.M

Lupari

S.P

.Gu

S.G

.Colle

Tom

bolo

Trebaseleghe

Vigodarzere

Vigonza

Villa del C

onte

Villafranca

Villanova

ATTENDANCE

Page 15: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

RESULTS

PATHOLOGY CASES PERCENTAGES

ABDOMINAL AORTIC ANEURYSM

31 0.3 %

COMMON ILIAC ARTERY ANEURISM

21 0.2 %

ABDOMINAL AORTIC ECTASIA

111 1 %

COMMON ILIAC ARTERY ECTASIA

696 6 %

Page 16: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

PREVALENCE OF PATHOLOGY IN TOTAL STUDIED POPULATION (11425)

3121

111

696

0

100

200

AAA AIC EAA EAIC

(6% )

(1% )

(0.2% )

(0.3% )

Page 17: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

PREVALENCE OF PATHOLOGY IN TOTAL EXAMINED POPULATION ACCORDING TO SEX

301

201

98

13

612

84

M

F

AAA AAIC EAA EAIC

Page 18: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

1211

3392

4177

1629

7021

597 597791

0

1000

2000

3000

4000

hear

t dise

ase

obes

ity

hipe

rchol

diab

etes

HBP

smoke

cv sur

gery

fam

iliarity

PREVALENCE OF RISK FACTOR’S DISTRIBUTION IN TOTAL STUDY POPULATION (11426)

(10.6% )

(29.7% )

(36.6%)

(14.3% )

(61.4% )

(5.2% )

(1.6% )

(5.2% )

Page 19: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

PREVALENCE OF RISK FACTOR’S DISTRIBUTION IN TOTAL AAA AND AIC AFFECTED POPULATION (52)

20 21 21

15

32

12

0

8

0

10

20

hear

t dise

ase

obes

ity

hype

rcho

l

diab

etes

HBP

smoke

cv sur

gery

fam

iliarity

(38.46% ) (40.4% ) (40.4% )

(28.8% )

(61.5% )

(23% )

(0% )

(15.4% )

Page 20: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

PREVALENCE OF RISK FACTOR’S DISTRIBUTION IN TOTAL EAA AND EAIC AFFECTED POPULATION (696)

128235 266

100

418

69

61

14

0

50

100

hear

t dise

ase

obes

ity

hype

rcho

l

diab

etes

HBP

smoke

cv sur

gery

fam

iliarity

(18.3% ) (33.8 % ) (38.2% )

(14.4% )

(60% )

(9.9% ) (8.8% )

(2% )

Page 21: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

DISCUSSION

ASYMPTOMATICPATHOLOGY

ASYMPTOMATICPATHOLOGY

AORTO-ILIACECTASIA

AORTO-ILIACECTASIA

CARDIOVASCULAR

RISK

CARDIOVASCULAR

RISK

AAA WANTED

PROJECT

AAA WANTED

PROJECT

FAMILIARITY FAMILIARITY

Page 22: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

CONCLUSIONS

ASYMPTOMATICPATHOLOGY

ASYMPTOMATICPATHOLOGY AORTO-ILIAC

ECTASIAAORTO-ILIAC

ECTASIA

AAA WANTEDScreening

68-74

AAA WANTEDScreening

68-74

AAA FOLLOW UP

AAA FOLLOW UP

AAA FAMILY Families > 60 years

AAA FAMILY Families > 60 years

Project development

Project development

FAMILIARITY FAMILIARITY

SURGERY

SURGERY

CARDIOVASCULAR

RISK

CARDIOVASCULAR

RISK

CHECK UP

CHECK UP

Page 23: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting
Page 24: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

Responsabile del Progetto: Dr F. FaresinTelefono: 049.9424588

Segreteria organizzativa: Vania Zen - Sabrina ZanovelloTelefono: 049.9424794

E-mail:[email protected]

Responsabile del Progetto: Dr F. FaresinTelefono: 049.9424588

Segreteria organizzativa: Vania Zen - Sabrina ZanovelloTelefono: 049.9424794

E-mail:[email protected]

Page 25: " AAA WANTED " 2012  S Paulo Vascular Surgery Meeting

Thank you