PATRIZIO CASTELLI

CHIRURGIA VASCOLAREDIPARTIMENTO DI SCIENZE CHIRURGICHE E MORFOLOGICHE

UNIVERSITA’ DEGLI STUDI DELL’INSUBRIAA.O.U. OSPEDALE DI CIRCOLO E “FONDAZIONE MACCHI” - VARESE

L’ ANEURISMA AORTICOADDOMINALE

• Holt PJE, et al. Provider volume and long-term outcome after elective abdominal aortic aneurysm repair.Br J Surg 2012;99:666-672

• 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

• Barshes NR, et al. Increasing complexity in the open surgical repair of abdominal aortic aneurysms.Ann Vasc Surg 2012;26:10-17

• Schanzer A, et al. Vascular surgery training trends rfom 2001-2007: a substantial increase in total procedure volume is driven by escalating endovascularprocedure volume and stable open procedure volume.J Vasc Surg 2009;49:1339-1344

• McPhee JT, et al. Surgeon case volume, not institution case volume, is the primary determinant of in-hospital mortality after elective open abdominalaortic aneurysm repair.J Vasc Surg 2011;53:591-599

• Landon BE, et al. Volume-outcome relationship and abdominal aortic aneurysm repair.Circulation 2010;122:1290-1297

• 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

• Chadi SA, et al. Trend in management of abdominal aortic aneurysmsJ 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 databaseBr J Surg 2012;99:673-679

• 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

IUXTARENALE P.A.U. DISSECANTEPSEUDOSOTTORENALE

• PREVALENZA DIAGNOSI di A.A.A.

TRATTAMENTO di A.A.A.

ROTTI

INTATTI

“SHIFT OF THE PARADIGM”

• CASI EVAR

• CASI ASA IV

• CASI 80enni

• COMPLICANZE: TASSO PIU’ ELEVATO @ 30g-6m

• SOPRAVVIVENZA SOVRAPPONIBILE > 2y

•

•

• DEFINIZIONE VOLUME

DELL’OSPEDALE (“PROVIDER”)

DEL CHIRURGO

RIFERIMENTO CONDIVISO: > 30 CASI/y

40.3%

59.7%

• MORTALITA’ HVH

SUPERIORITA’ ESTESAAD OLTRE 2 ANNI

STRETTAMENTE CORRELATAA MORTALITA’ @ 30d

“SECONDARY MANAGEMENT”

NONOSTANTE“HIGH RISK”

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

• PIU’ FREQUENTEMENTE NEL CONTESTO DI HVH

• PIU’ FREQUENTEMENTE SONO HVS

• MA SOLO 27% DEGLI A.A.A. TRATTATI DA CH VASCOLARI

• rA.A.A. PIU’ FREQUENTEMENTE OPERATI DA GENERALI

• MORTALITA’ A.A.A. DETERMINATA DA

“EFFETTO ADDITIVO”:VOLUME ANNUALEDI CHIRURGO E HOSP

DISCIPLINA DISPECIALIZZAZIONE

TEACH44.6%

62.9%

HIGH VOLUMEHOSPITAL (A.A.A.)

URBAN29.2%

N-TEACH12.6%

RURAL3.4%

34.2%

EVAR

• NUM DEI CLAMP SOVRARENALE (14.1% vs 30.3%)

• CLAMP SOVRARENALE SOPRAVVIVENZA, @5-10y (P = .04)

• COMPLICANZE PER CLAMP SOVRARENALE (25.8% vs 31.9%)