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
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
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
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
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
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
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)
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
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
QUESTIONNAIRE FOR PRINCIPAL VASCULAR RISK FACTORS
Heart disease
Obesity
Hypercholesterolemia
Diabetes
Smoke
High blood pressure
Familiarity for abdominal aortic aneurysm
Previous cardiovascular surgery
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
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
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
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 %
PREVALENCE OF PATHOLOGY IN TOTAL STUDIED POPULATION (11425)
3121
111
696
0
100
200
AAA AIC EAA EAIC
(6% )
(1% )
(0.2% )
(0.3% )
PREVALENCE OF PATHOLOGY IN TOTAL EXAMINED POPULATION ACCORDING TO SEX
301
201
98
13
612
84
M
F
AAA AAIC EAA EAIC
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% )
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% )
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% )
DISCUSSION
ASYMPTOMATICPATHOLOGY
ASYMPTOMATICPATHOLOGY
AORTO-ILIACECTASIA
AORTO-ILIACECTASIA
CARDIOVASCULAR
RISK
CARDIOVASCULAR
RISK
AAA WANTED
PROJECT
AAA WANTED
PROJECT
FAMILIARITY FAMILIARITY
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
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]
Thank you