An vrisme aorte abdominale aaa consensus canadien acc aha ssvq 2006
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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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An vrisme 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

Can J Cardiol 2005; 21(12): 997-1006

www.ccs.ca


Disclosures divulgations andr roussin md

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


Aaa d finition et pr valence

AAADéfinition et prévalence

AAA : Diamètre > 3 cm (AP en général)

ACC/AHA 2005


Aaa examen physique sensibilit pour le d pistage

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


Aaa et an vrismes des extr mit s histoire naturelle g n rale

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


Aaa 5 5 cm risque de rupture us va study

AAA ≥ 5.5 cmRisque de rupture: US VA Study

Consensus canadien MAP CCS 2005


Aaa en fonction du sexe risque de rupture s rie de kingston ontario

AAA en fonction du sexeRisque de rupture: série de Kingston, Ontario

Consensus canadien MAP CCS 2005


Aaa petits vs gros risque de rupture uk small aneurysm trial 1999

AAA : petits vs grosRisque de rupture: UK Small Aneurysm Trial 1999

ACC/AHA PAD Consensus 2005


Aaa perspective globale risque de rupture acc aha 2005

AAA : perspective globaleRisque de rupture: ACC/AHA 2005

ACC/AHA PAD Consensus 2005


An vrismes visc raux 2 3 x moins fr quents que aaa

Anévrismes viscéraux2 - 3 X moins fréquents que AAA


Aaa d pistage consensus am ricain 2004

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


Aaa d pistage usptf 2005

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.


Aaa suivi et intervention

AAASuivi et Intervention

> 1 cm/an*

* CCS 2005

Sakalihasan N et al. Lancet 2005; 365: 1577-89


Canadian cardiovascular society consensus conference 2005 peripheral arterial disease

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


Recommendations ccs 2005 aneurysm screening

Recommendations CCS 2005Aneurysm Screening

Tom Lindsay


Recommendations ccs 2005 aaa follow up based on initial size

Recommendations CCS 2005AAA Follow-up Based on Initial Size

Tom Lindsay


Aaa traitement m dical

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


Aaa le r le de jnk et des mmp

AAALe rôle de JNK et des MMP

Verma S, Lindsay T. NEJM 2006; 354: 2067-8


Aaa le r le de jnk et des mmp1

AAALe rôle de JNK et des MMP

Verma S, Lindsay T. NEJM 2006; 354: 2067-8


Sources d information

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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