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Jean-Marc Alsac , et al
Services de Chirurgie Cardiovasculaire,
Anesthsie-Ranimation, Radiologie cardiovasculaire, Cardiologie,
HTA, Mdecine vasculaire, Gntique
Possibilit dHliportage
SOS Aorte
Comptences multidisciplinaires:
Chirurgicales Cardio-Vasculaires et Endovasculaires
Ranimation CardioloVasculaire
Radiologiques - AngioScanners
disponibles 24/7 ( 56 09)
Proposer au patient le traitement le plus rapide et
surtout le plus adapt sa pathologie
(et non celui qui est disponible lheure de sa prsentation)
Suspicion dUrgence Aortique
Algorithmes dcisionnels
Bloc op. CCV
133
150
2010
2011
84
100
2012
55 2013
50
2014
2015
2016
0 2017
SOS Aorte
Analyse de Fv 2010 Juil 2016 : N=833
JACC
Population
Patients characteristics
(n=833)
Age - years (sd) 66 (16)
95%
Male (%) 564 (67.7) Risk factors for the diagnosis Odds P
Hypertension (%) 484 (58.1)
Confidence
of Acute Aortic Disease ratio value
Active Smoking (%) 174 (20.9) Interval
Diabete (%) 73 (8.8) Limb ischemia 5.35 1.51 18.89 0.009
History of abdominal aortic aneurysm (%) 128 (15.4) History of abdominal aortic aneurysm 3.61 1.70 7.64 0.001
History of thoracic aortic aneurysm (%) 106 (12.7) New murmur of aortic insufficiency 3.22 1.60 6.48 0.001
History of aortic surgery (%) 123 (14.8) Migrating pain 3.06 1.34 6.98 0.008
History of aortic heart valve surgery (%) 45 (5.4)
History of thoracic aortic aneurysm 2.63 1.18 5.89 0.019
History of coronary artery bypass surgery
27 (3.2) Pericardial effusion 1.92 1.01 3.63 0.045
(%)
Age (per year) 1.03 1.02 1.04 <0.001
Connective tissue disease (%) 21 (2.5)
Known aortic valve disease (%) 50 (6.0)
Sudden pain 0.48 0.30 0.76 0.002
Recent aortic manipulation (%) 11 (1.3) Sudden pain AND Focal neurologic deficit 4.13 1.01 16.94 0.049
Familial history of aortic dissection (%) 5 (0.6) Sudden pain AND SBP differential * 3.83 1.30 11.30 0.015
Personal history of aortic dissection (%) 22 (2.6) SBP differential * 0.23 0.10 0.55 0.001
Inflammatory vasculitides (%) 3 (0.4) SBP differential * AND History of aortic
Referred from primary center (%) 444 (53.3)
10.30 1.45 73.05 0.020
surgery
SOS Aorte
SAMU
Hliportage = 9,4 %
SAMU
2ndaire SAMU 1aire
43% ou BSPP
51%
Diagnostic final
Non CV
23% CV
77%
SOS Aorte
Diagnostics cardio-vasculaires
DIAGNOSTIC N % Dcs %
dcs
Anvrisme de laorte abdominale (AAA) 111 19 24 21,6
Intervention Urgente
Complications Tardives
Progression Anvrysmale vers la rupture:
Jeune / Aorte dilate / Dystrophie
Intervention Prventive
Complications Aigues
Type A
Mortalit
1% / h 50% @ 48 h
30% @ 24 h 90% @ 1 month
72 68
Suivi 5 ans P
TEVAR TMO
Progression
27.0 % 46.1 % .04
Anvrysmale
2 ans
1/3 3 ans
4 ans
2/3 5 ans
Intrt du traitement prventif
Intrt du traitement prventif
Rsultats 3 ans
Mdecin gnraliste de 63 ans (tout juste en retraite)
Rsultats 2 ans
Patient de 45 ans avec Dissection de Type A
Patient de 23 ans
Marfan
Programme SOS Aorte
Exprience des Dissections Aortiques lHEGP:
Interventions Standardises
26 MAI 2018
jean-marc.alsac@egp.aphp.fr