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. - PowerPoint PPT Presentation
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AAA : petits vs grosAAA : petits vs grosRisque de rupture: UK Small Aneurysm Risque de rupture: UK Small Aneurysm
Trial 1999Trial 1999
DiamètreDiamètreRisque de rupture sur Risque de rupture sur un suivi moyen de 7 un suivi moyen de 7 ans chez les patients ans chez les patients
NON opérésNON opérés
3 - 3.9 cm3 - 3.9 cm 2.1%2.1%
4 - 5.5 cm4 - 5.5 cm 4.6%4.6%
≥ ≥ 5.6 cm5.6 cm 20%20%ACC/AHA PAD Consensus 2005ACC/AHA PAD Consensus 2005
A RoussinA Roussin
AAA : perspective globaleAAA : perspective globaleRisque de rupture: ACC/AHA 2005Risque de rupture: ACC/AHA 2005
DiamètreDiamètre Risque Risque GLOBALGLOBAL de rupturede rupture
Risque Risque ANNUELANNUEL de rupturede rupture
> 5.0 cm> 5.0 cm 20%20% 4%4%
> 6.0 cm> 6.0 cm 40%40% 7%7%
> 7.0 cm> 7.0 cm > 50%> 50% 20%20%
ACC/AHA PAD Consensus 2005ACC/AHA PAD Consensus 2005
A RoussinA Roussin
Anévrismes viscérauxAnévrismes viscéraux2 - 3 X moins fréquents que AAA2 - 3 X moins fréquents que AAA
LocalisationLocalisation SitesSites
SpléniqueSplénique 60%60%
HépatiqueHépatique 20%20%
Mésentérique Sup.Mésentérique Sup. 6%6%
Tronc coéliaqueTronc coéliaque 4%4%
AutresAutres 10%10%
A RoussinA Roussin
AAAAAADépistage: Consensus américain 2004Dépistage: Consensus américain 2004
Abdominal aortic aneurysm can easily be Abdominal aortic aneurysm can easily be missed, especially in obese patients, so that missed, especially in obese patients, so that echography is the preferred method of echography is the preferred method of diagnosis in diagnosis in high-risk patients, such as men high-risk patients, such as men aged 60 to 85 yearsaged 60 to 85 years, women aged 60 to 85 , women aged 60 to 85 years with cardiovascular risk factors and years with cardiovascular risk factors and men and women older than 50 years with a men and women older than 50 years with a family history of AAAfamily history of AAA
Kent KC. Screening for abdominal aortic Kent KC. Screening for abdominal aortic aneurysm: A consensus statement.aneurysm: A consensus statement.
The USPSTF found good evidence that The USPSTF found good evidence that screening for AAA and surgical repair of screening for AAA and surgical repair of large large AAAs ( 5.5 cm) in men age 65 to 75 AAAs ( 5.5 cm) in men age 65 to 75 years who have ever smokedyears who have ever smoked (current and (current and former smokers) leads to decreased AAA-former smokers) leads to decreased AAA-specific mortality.specific mortality.
There is good evidence that abdominal There is good evidence that abdominal ultrasonography, performed in asetting with ultrasonography, performed in asetting with adequate quality assurance (…), is an adequate quality assurance (…), is an accurate screening test for AAA.accurate screening test for AAA.
Ann Intern Med. 2005; 142:198-202Ann Intern Med. 2005; 142:198-202.
A RoussinA Roussin
AAAAAASuivi et Intervention Suivi et Intervention
Sakalihasan N et al. Lancet 2005; 365: 1577-89Sakalihasan N et al. Lancet 2005; 365: 1577-89
> 1 cm/an*
* CCS 2005
A RoussinA Roussin
Canadian Cardiovascular Society Canadian Cardiovascular Society Consensus Conference 2005Consensus Conference 2005Peripheral Arterial DiseasePeripheral Arterial Disease
Beth ABRAMSON, TorontoBeth ABRAMSON, Toronto Sonia ANAND, HamiltonSonia ANAND, Hamilton Tom FORBES, LondonTom FORBES, London Anil GUPTA ,BramptonAnil GUPTA ,Brampton Ken HARRIS, LondonKen HARRIS, London Vic HUCKELLVic HUCKELL, , Vancouver Vancouver Asad JUNAID, WinnipegAsad JUNAID, Winnipeg
Tom LINDSAY, TorontoTom LINDSAY, Toronto Finlay McALISTER, EdmontonFinlay McALISTER, Edmonton Andre ROUSSIN, MontrealAndre ROUSSIN, Montreal Jacqueline SAW, VancouverJacqueline SAW, Vancouver Koon TEO, HamiltonKoon TEO, Hamilton A. G TURPIE, HamiltonA. G TURPIE, Hamilton Subodh VERMA, TorontoSubodh VERMA, Toronto
Women aged 65 who have cardiovascular Women aged 65 who have cardiovascular disease and positive family history of disease and positive family history of AAAAAA
3C3C
Men aged 50 and above with a positive Men aged 50 and above with a positive family historyfamily history 3C3C
<3.0 cm<3.0 cm Repeat ultrasound follow-up in 3-5 Repeat ultrasound follow-up in 3-5 yearsyears 1A1A
3.1-3.5cm3.1-3.5cm Repeat ultrasound in 3 yearsRepeat ultrasound in 3 years 1A1A3.6-3.9 cm3.6-3.9 cm Repeat ultrasound in 2 yearsRepeat ultrasound in 2 years 1A1A
4.0-4.5 cm4.0-4.5 cm Repeat ultrasound in 1 yearRepeat ultrasound in 1 year 1A1A
4.6 cm or >4.6 cm or >Referral to Vascular Surgeon and Referral to Vascular Surgeon and
repeat ultrasound every 3-6 repeat ultrasound every 3-6 monthsmonths
1A1A
If > 1cm growth If > 1cm growth in 1 yearin 1 year Referral to Vascular SurgeonReferral to Vascular Surgeon 1A1A
Recommendations CCS 2005Recommendations CCS 2005AAA Follow-up Based on Initial SizeAAA Follow-up Based on Initial Size
Tom Lindsay
A RoussinA Roussin
AAAAAATraitement médicalTraitement médical
Traitement des facteurs de risqueTraitement des facteurs de risque Tabagisme surtoutTabagisme surtout
B-Bloqueurs pour les AAA > 5 cm ?B-Bloqueurs pour les AAA > 5 cm ? Inefficaces pour AAA < 5 cmInefficaces pour AAA < 5 cm Marfan: diminution des complications Ao.Marfan: diminution des complications Ao.
IECA ? (selon observation de cohorte)IECA ? (selon observation de cohorte) Réduction risque rupture: RRR ajusté 0.83Réduction risque rupture: RRR ajusté 0.83 Pas d’effet par autres Tx HTA y compris Pas d’effet par autres Tx HTA y compris BRABRA