Michael D Dake

Stanford University, Palo Alto, California, United States

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Publications (178)738.91 Total impact

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    ABSTRACT: Sustained benefits of drug-eluting stents in femoropopliteal arteries have not been demonstrated. This prospective, multinational, randomized study was designed to compare the 12-month safety and effectiveness of a polymer-free, paclitaxel-coated nitinol drug-eluting stent (DES) with percutaneous transluminal angioplasty (PTA) and provisional bare metal stent (BMS) placement in patients with femoropopliteal peripheral artery disease. Patients were randomly assigned to primary DES implantation (n=236) or PTA (n=238). Demographics and lesion characteristics were similar between groups (eg, average lesion length, approximately 65±40 mm). One hundred twenty patients had acute PTA failure and underwent secondary random assignment to provisional DES (n=61) or BMS (n=59). Primary end points were the 12-month rates of event-free survival and patency in the primary DES and PTA groups. Compared with the PTA group, the primary DES group exhibited superior 12-month event-free survival (90.4% versus 82.6%; P=0.004) and primary patency (83.1% versus 32.8%; P<0.001), satisfying the primary hypotheses. In the secondary evaluations, (1) the primary DES group exhibited superior clinical benefit compared with the PTA group (88.3% versus 75.8%; P<0.001), (2) the provisional DES group exhibited superior primary patency (89.9% versus 73.0%; P=0.01) and superior clinical benefit (90.5% and 72.3%, P=0.009) compared with the provisional BMS group, and (3) the stent fracture rate (both DES and BMS) was 0.9% (4/457). Femoropopliteal peripheral artery disease treatment with the paclitaxel-eluting stent was associated with superior 12-month outcomes compared with PTA and provisional BMS placement.
    Circulation Cardiovascular Interventions 09/2011; 4(5):495-504. DOI:10.1161/CIRCINTERVENTIONS.111.962324 · 6.98 Impact Factor
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    Journal of vascular and interventional radiology: JVIR 05/2011; 22(5):587-93. DOI:10.1016/j.jvir.2011.03.007 · 2.15 Impact Factor
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    ABSTRACT: The Society for Vascular Surgery Outcomes Committee, including ad hoc members from Society of Thoracic Surgeons, American Association of Thoracic Surgery, and Society for Interventional Radiology, collected outcomes of patients with traumatic thoracic aortic transections treated with endovascular grafts. Results through 1 year of follow-up are reported. Data from five physician-sponsored investigational device exemption clinical trials from 2000 to 2008 were entered using standardized forms and definitions. Adverse events were reported early (≤30 days) and late (>30 days) by body system. Major adverse events included one or more of the following: death, stroke, myocardial infarction, renal failure, respiratory failure, paralysis, or bowel ischemia. There were 60 symptomatic patients (68.3% men; mean age, 46 years) with traumatic aortic transections, of which 97% were due to a motor vehicle accident and 3% were related to other blunt trauma. The average total injury severity score was 39, most with involvement of the chest and abdomen. The average surgical time was 125 minutes. The mean hospital length of stay was 17 days. Associated procedures for the management of nonaortic injuries occurred in 51.7%. All-cause mortality was 9.1% at 30 days and 14.4% at 1 year. One or more major adverse events occurred in 23.3% of the patients, major adverse events occurred early in 20.0% and late in 3.6%. Death accounted for 41.7% of the early and all of the late major adverse events. Early adverse events included 16.7% pulmonary, 13.3% neurologic, and 11.7% vascular complications. Late adverse events included one patient (1.8%) with pulmonary failure and one patient (1.8%) who died of an unknown cause. One-year results of endograft placement for the management of patients with traumatic aortic injury are acceptable. Most cases treated were due to motor vehicle accident and associated with multiple coexisting injuries. Approximately three-quarters of the deaths occurred ≤30 days, indicating the acute severity of the condition. Although the relatively low rates of adverse and major adverse events are consistent with what is anticipated in an otherwise healthy population, future device and procedural developments may facilitate improved outcomes in the future.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 04/2011; 53(4):1091-6. DOI:10.1016/j.jvs.2010.11.126 · 2.98 Impact Factor
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    ABSTRACT: To evaluate the pharmacokinetics and safety of the Zilver PTX Drug-Eluting Stent (Cook Medical, Bloomington, Indiana) in a normal porcine artery model. Pharmacokinetic analyses were performed using 18 pigs, each implanted with four paclitaxel-coated stents. Paclitaxel remaining on the stents, delivered locally (to artery wall), regionally (to adjacent and downstream muscle), and systemically (to plasma), was determined at various times through 56 days. For safety evaluation, local, regional, and systemic responses were grossly and histologically assessed at 1 month, 3 months, and 6 months in 21 additional pigs and compared with the responses to bare metal stents in 21 separate pigs. Stents delivered approximately 95% of the total paclitaxel within 24 hours after deployment. Nonetheless, there were sustained paclitaxel levels in the artery wall through 56 days, maintained at approximately 20% of the peak level through 14 days. Very little paclitaxel was distributed regionally or systemically, becoming undetectable in plasma at 10 hours. Complete necropsy, hematology, and serum chemistry revealed no adverse effects associated with the paclitaxel-coated stents. Within 3 months, vessels with both paclitaxel-coated and bare metal stents showed comparable, complete healing. The Zilver PTX stent appears to be safe, achieves sustained paclitaxel levels in the artery wall, and shows complete vessel healing comparable to bare metal stents within 3 months.
    Journal of vascular and interventional radiology: JVIR 03/2011; 22(5):603-10. DOI:10.1016/j.jvir.2010.12.027 · 2.15 Impact Factor
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    ABSTRACT: This study analyzed 1-year outcome after thoracic endovascular aortic repair (TEVAR) in patients with complicated type B aortic dissection (cTBAoD) who had rupture or malperfusion and symptom onset ≤14 days (acute), 15 to 30 days (subacute), and 31 to 90 days (chronic) until required intervention. The main focus of this report is primarily on the acute cohort. Clinical data were systematically collected from five physician-sponsored investigational device exemption (IDE) clinical trials between 2000 and 2008 using standardized definitions and forms. Adverse events were reported early (≤30 days) and late (>30 days) by body system. Major adverse events included death, stroke, myocardial infarction, renal failure, respiratory failure, paralysis, and bowel ischemia. There were 99 cTBAoD patients: 85 were acute, 11 were subacute, and 3 were chronic. Among the acute patients, 31.8% had rupture and 71.8% had malperfusion, including 55.7% lower extremity, 36.1% renal, 19.7% visceral, 8.2% other, and 3.3% spinal cord (patients may have more than one source). Rupture and malperfusion were both reported for three acute patients. Additional findings for the acute cohort included pain (76.5%), hypertension (43.5%), and bleeding (8.2%); comorbidities included hypertension (83.5%), current/past smoking history (69.8%), and diabetes (12.9%). The main focus of this analysis was the acute cohort (n = 85). Age averaged 59 years (72.9% male). Early adverse events included pulmonary (36.5%), vascular (28.2%), renal (25.9%), and neurologic (23.5%). Early major adverse events occurred in 37.6% of patients, including death (10.6%), stroke (9.4%), renal failure (9.4%), and paralysis (9.4%); late adverse events included vascular (15.8%), cardiac (10.5%), gastrointestinal (6.6%), and hemorrhage (5.3%). The point-estimate mortality rate was 10.8 (95% confidence interval [CI], 4.1-17.5) at 30 days and 29.4 (95% CI, 18.4-40.4) at 1 year, when 34 patients remained at risk. Emergency TEVAR for patients with cTBAoD (malperfusion or rupture) provided acceptable mortality and morbidity results out to 1 year. Manufacturers can use this 30-day mortality point-estimate of 10.8 (95% CI, 4.1-17.5) for the acute cohort to establish a performance goal for use in single-arm commercial IDE trials if the Food and Drug Administration and other regulatory bodies concur.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 02/2011; 53(4):1082-90. DOI:10.1016/j.jvs.2010.11.124 · 2.98 Impact Factor
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    Biomedical Engineering, Trends in Materials Science, 01/2011; , ISBN: 978-953-307-513-6
  • Jacob M Waugh, Jane Lee, Michael D Dake, Dan Browne
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    ABSTRACT: Considerations in rational designs of CPP-based transcutaneous delivery systems are described. Impact of design considerations of nonclinical and clinical results are presented in detail.
    Methods in molecular biology (Clifton, N.J.) 01/2011; 683:553-72. DOI:10.1007/978-1-60761-919-2_39 · 1.29 Impact Factor
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    ABSTRACT: Carotid atherosclerotic plaque rupture is thought to cause transient ischemic attack (TIA) and ischemic stroke (IS). Pathological hallmarks of these plaques have been identified through observational studies. Although generally accepted, the relationship between cerebral thromboembolism and in situ atherosclerotic plaque morphology has never been directly observed noninvasively in the acute setting. Consecutive acutely symptomatic patients referred for stroke protocol magnetic resonance imaging/angiography underwent additional T1- and T2-weighted carotid bifurcation imaging with the use of a 3-dimensional technique with blood signal suppression. Two blinded reviewers performed plaque gradings according to the American Heart Association classification system. Discharge outcomes and brain magnetic resonance imaging results were obtained. Image quality for plaque characterization was adequate in 86 of 106 patients (81%). Eight TIA/IS patients with noncarotid pathogenesis were excluded, yielding 78 study patients (38 men and 40 women with a mean age of 64.3 years, SD 14.7) with 156 paired watershed vessel/cerebral hemisphere observations. Thirty-seven patients had 40 TIA/IS events. There was a significant association between type VI plaque (demonstrating cap rupture, hemorrhage, and/or thrombosis) and ipsilateral TIA/IS (P<0.001). A multiple logistic regression model including standard Framingham risk factors and type VI plaque was constructed. Type VI plaque was the dominant outcome-associated observation achieving significance (P<0.0001; odds ratio, 11.66; 95% confidence interval, 5.31 to 25.60). In situ type VI carotid bifurcation region plaque identified by magnetic resonance imaging is associated with ipsilateral acute TIA/IS as an independent identifier of events, thereby supporting the dominant disease pathophysiology.
    Circulation 11/2010; 122(20):2031-8. DOI:10.1161/CIRCULATIONAHA.109.866053 · 14.95 Impact Factor
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    ABSTRACT: To review an experience with the Amplatzer vascular plug (AVP) for prevention of type II endoleaks during endovascular aneurysm repair (EVAR) of thoracic and thoracoabdominal aneurysms. Retrospective review was undertaken of 14 patients undergoing transcatheter occlusion of the left subclavian (n = 12) or celiac artery (n = 2) with the AVP as part of EVAR of thoracic and thoracoabdominal aneurysms at a single institution. Procedural criteria evaluated were success at target vessel occlusion, the number of AVPs used, use of adjunctive embolization devices, and embolization-related ischemic end-organ events. Follow-up imaging criteria included evaluation of persistent target vessel occlusion, evidence of device migration, and the presence and characterization of endoleak secondary to AVP failure. Complete target vessel occlusion was documented for all cases. In six cases, more than one AVP was placed, with an average of 1.5 devices per patient. In two cases, adjunctive coils were placed. Computed tomographic or magnetic resonance angiography follow-up was available for all patients (mean follow-up, 419 days; range 28-930 d). No case showed evidence of device migration or type II endoleak resulting from AVP failure. There was a single instance of left subclavian artery recanalization without type II endoleak. There were no embolization-related ischemic end-organ events. Transcatheter arterial occlusion of the subclavian and celiac arteries with the AVP is a valuable adjunct to endografting in cases in which side branch embolization is necessary to extend the landing zone.
    Journal of vascular and interventional radiology: JVIR 10/2010; 21(10):1501-7. DOI:10.1016/j.jvir.2010.05.021 · 2.15 Impact Factor
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    Circulation 06/2010; 121(25):2780-804. DOI:10.1161/CIR.0b013e3181e4d033 · 14.95 Impact Factor
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    ABSTRACT: To determine the clinical importance of the bird-beak configuration after thoracic endovascular aortic repair (TEVAR). The institutional review board approved this retrospective study and waived the requirement to obtain informed consent from patients. Sixty-four patients (40 men, 24 women; mean age, 64 years) who underwent TEVAR were evaluated. The treated diseases included dissection (n = 29), degenerative aneurysm (n = 13), acute traumatic transection (n = 8), pseudoaneurysm (n = 4), penetrating aortic ulcer (n = 6), intramural hematoma (n = 2), and mycotic aneurysm (n = 2). Bird-beak configuration, defined as the incomplete apposition of the proximal endograft with a wedge-shaped gap between the device and the aortic wall, was assessed with postprocedural CT angiography. The presence and length of the bird-beak configuration were compared with the formation of endoleaks and adverse clinical events. Endoleaks were detected in 26 (40%) of the 64 patients, including 14 with type Ia endoleak formation, one with type Ib endoleak formation, six with type II endoleak formation (from the left subclavian artery), two with type IIo endoleak formation (from other arteries), and three with type III endoleak formation. Bird-beak configuration was observed in 28 (44%) of 64 patients and correlated significantly with the risk of developing a type Ia or IIa endoleak (P < .01). Mean bird-beak length was significantly longer (P < .01) in patients with a type Ia or II endoleak (mean length, 14.3 and 13.9 mm, respectively) than in patients without endoleaks (mean length, 8.4 mm). Adverse events included early aortic-related death in three patients, additional treatment for endoleak in eight patients, and stent-graft collapse or infolding in six patients. Detection of bird-beak configuration is helpful in the prediction of adverse clinical events after TEVAR.
    Radiology 05/2010; 255(2):645-52. DOI:10.1148/radiol.10091468 · 6.21 Impact Factor
  • RöFo - Fortschritte auf dem Gebiet der R 03/2010; 182. DOI:10.1055/s-0030-1252600 · 1.96 Impact Factor
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    Carlos H Timaran, Michael D Dake
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 10/2009; 50(3):705; author reply 705. DOI:10.1016/j.jvs.2009.04.070 · 2.98 Impact Factor
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    ABSTRACT: This study evaluated the feasibility, efficacy, and outcome of endovascular therapy combined with immunosuppressive therapy for aortic pseudoaneurysms in patients with Behçet disease. Between April 2002 and April 2008, 12 pseudoaneurysms (9 involving the intrarenal abdominal aorta, 1 at the suprarenal level, and 2 in the supraceliac aorta) in nine men and one woman with Behçet disease were evaluated at Peking Union Medical Center (PUMC). Three bifurcated stent grafts and seven tubular stent grafts, including two fenestrated stent grafts, were deployed. All 10 patients received immunosuppressive therapy after the implant procedure. All patients underwent successful endovascular therapy without major complications during the 30 days immediately after the procedure. One patient with two aneurysms had treatment of only the larger infrarenal symptomatic aneurysm, but the smaller suprarenal pseudoaneurysm was not addressed because of its proximity to mesenteric branches. During a mean follow-up of 25.8 months (range, 6-50 months), nine aneurysms resolved completely in eight patients. The only untreated aneurysm, which coexisted with a treated lesion, remained stable under imaging observation. Three aneurysms recurred in two patients. At 6 months, one patient presented with a new aneurysm at the femoral artery access site for stent graft introduction and another formed at the proximal margin of the stent graft. Despite medical advice, he had stopped immunotherapy. He died from aneurysm rupture 8 months after stent deployment. Another patient with recurrent aneurysmal disease at the distal margin of the primary stent was successfully treated with an additional stent graft. These two were the only patients who did not adhere to taking immunosuppressant medicine after discharge. Endovascular stent graft placement combined with immunosuppressive treatment for aortic pseudoaneurysms in Behçet disease is a feasible and effective management option. Long-term immunosuppressive therapy after endovascular repair is important to limit pseudoaneurysm recurrence.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 09/2009; 50(5):1025-30. DOI:10.1016/j.jvs.2009.06.009 · 2.98 Impact Factor
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    ABSTRACT: We sought to review the clinical sequelae and imaging manifestations of thoracic aortic endograft collapses and infoldings and to evaluate minimally invasive methods of repairing such collapses. Two hundred twenty-one Gore endografts (Excluder, TAG; W. L. Gore & Associates, Inc, Flagstaff, Ariz) were deployed in 145 patients for treatment of pathologies including aneurysms and pseudoaneurysms, dissections, penetrating ulcers, transections, fistulae, mycotic aneurysms, and neoplastic invasions in 6 different prospective trials at a single institution from 1997 to 2007. Device collapses and infoldings were analyzed retrospectively, including review of anatomic parameters, pathologies treated, device sizing and selection, clinical sequelae, methods of repair, and outcome. Six device collapses and infoldings were identified. Oversized devices placed into small-diameter aortas and imperfect proximal apposition to the lesser curvature were seen in all proximal collapses, affecting patients with transections and pseudoaneurysms. Infoldings in patients undergoing dissection represented incomplete initial expansion rather than delayed collapse. Delayed collapse occurred as many as 6 years after initial successful deployment, apparently as a result of changes in the aortic configuration from aneurysmal shrinkage. Clinical manifestations ranged from life-threatening ischemia to complete lack of symptoms. Collapses requiring therapy were remedied percutaneously by bare stenting or in one case by branch vessel embolization. Use of oversized devices in small aortas carries a risk of device failure by collapse, which can occur immediately or after years of delay. When clinically indicated, percutaneous repair can be effectively performed.
    The Journal of thoracic and cardiovascular surgery 09/2009; 138(2):324-33. DOI:10.1016/j.jtcvs.2008.12.007 · 3.99 Impact Factor
  • Daniel G Tang, Michael D Dake
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    ABSTRACT: Medical management remains the standard treatment modality for acute uncomplicated descending aortic dissections. Intervention (by either open surgery or an endovascular approach) is currently reserved for patients who present with or subsequently develop complications (ie, complicated dissections). Despite the success of medical therapy in the acute management of uncomplicated dissection, long-term morbidity and mortality are far from ideal. The introduction of thoracic endovascular aortic repair (TEVAR) has been associated with reductions in morbidity and mortality in the treatment of complicated dissections. There is limited data regarding TEVAR for acute uncomplicated dissections. Early results from the INSTEAD (Investigation of Stent Grafts in Patients with Type B Aortic Dissection) trial, a randomized trial for TEVAR in subacute/chronic uncomplicated dissections, were not favorable. The ADSORB (Acute Uncomplicated Aortic Dissection Type B: Evaluating Stent-Graft Placement or Best Medical Treatment Alone) trial, a randomized trial for TEVAR in acute dissections, is currently underway. Nonetheless, current data available, including multiple reports proposing a variety of predictive factors, suggest that there may be a subset of higher-risk patients with acute uncomplicated dissections who could benefit from TEVAR.
    Seminars in Vascular Surgery 09/2009; 22(3):145-51. DOI:10.1053/j.semvascsurg.2009.07.005 · 1.58 Impact Factor
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    Fabrizio Fanelli, Michael D Dake
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    ABSTRACT: Thoracic endovascular aortic repair (TEVAR) represents a minimally invasive technique alternative to conventional open surgical reconstruction for the treatment of thoracic aortic pathologies. Rapid advances in endovascular technology and procedural breakthroughs have contributed to a dramatic transformation of the entire field of thoracic aortic surgery. TEVAR procedures can be challenging and, at times, extraordinarily difficult. They require seasoned endovascular experience and refined skills. Of all endovascular procedures, meticulous assessment of anatomy and preoperative procedure planning are absolutely paramount to produce optimal outcomes. These guidelines are intended for use in quality-improvement programs that assess the standard of care expected from all physicians who perform TEVAR procedures.
    CardioVascular and Interventional Radiology 09/2009; 32(5):849-60. DOI:10.1007/s00270-009-9668-6 · 1.97 Impact Factor
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    ABSTRACT: The aim of this retrospective analysis was to assess the clinical consequences after intentional left subclavian artery (LSA) occlusion. Thirty-seven patients, 27 type B dissection and 10 thoracic aneurysm, with short proximal neck (less than 2 cm) underwent endovascular treatment with intentional exclusion of LSA origin. No immediate complications occurred. Mean arterial pressure gradient, between right and left arms, ranged from 15 to 45 mmHg. After a mean follow-up of 43.70 + or - 24.01 months, mild left arm symptoms secondary to flow reduction occurred in eight cases (21.6%) but only one required LSA transposition, after 8 months, for visual impairment. Type II endoleaks from excluded LSA occurred in 10 cases (27.0%): in seven patients, leaks were treated with coils and/or glue embolization; in one case, leak sealed spontaneously; one patient died before leak embolization could occur; one patient refused any further treatment. Intentional exclusion of the LSA may be justified when a longer proximal landing zone in the aortic arch is required.
    European Radiology 06/2009; 19(10):2407-15. DOI:10.1007/s00330-009-1433-3 · 4.34 Impact Factor
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    ABSTRACT: Endoleaks after stent-graft repair of aortic dissections are poorly understood but seem substantially different from those seen after aneurysm repair. We studied anatomic and clinical factors associated with endoleaks in patients who underwent stent-graft repair of complicated type B aortic dissections. From 2000 to 2007, 37 patients underwent stent-graft repair of acute (< or =14 days; n=23), subacute (15 to 90 days; n=10) or chronic (>90 days; n=4) complicated type B aortic dissections using the Gore Thoracic Excluder (n=17) or TAG stent-grafts (n=20) under an investigator-sponsored protocol. Endoleaks were classified as imperfect proximal seal, flow through fenestrations or branches, or complex (both). Variables studied included coverage of the left subclavian artery, aortic curvature, completeness of proximal apposition, dissection chronicity, and device used. Endoleaks were found during follow-up (mean, 22 months) in 59% of patients, and they were associated with coverage of the left subclavian artery (complex, P<0.001), small radius of curvature (type 1 and complex, P=0.05), and greatest length of unapposed proximal stent graft (complex, P<0.0001). During follow-up, 10 endoleaks resolved spontaneously, 6 required reintervention for false lumen dilatation, and 2 were stable without clinical consequences. Endoleaks are common after stent-graft repair of aortic dissection and may lead to false lumen enlargement necessitating reintervention. Anatomic complexities such as acute aortic curvature and covered side branches were associated with endoleaks, illustrating the need for dissection-specific device development.
    Circulation Cardiovascular Interventions 04/2009; 2(2):105-12. DOI:10.1161/CIRCINTERVENTIONS.108.819722 · 6.98 Impact Factor
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    ABSTRACT: La toma de decisiones clínicas en casos de aneurismas aórticos abdominales (AAA) asintomáticos debe tener en cuenta el riesgo de rotura del aneurisma, los riesgos del tratamiento, y las expectativas globales de supervivencia. El diámetro del AAA es el principal parámetro en la evaluación del riesgo de rotura. Se ha estudiado de forma exhaustiva la evaluación del riesgo perioperatorio, consiguiendo reducir la mortalidad intrahospitalaria a menos del 8% en casos de corrección abierta de alto riesgo y a menos del 3% con la reparación endovascular. El objetivo de este trabajo es determinar los factores de riesgo predictivos de supervivencia a los 2 años tras una corrección abierta o endovascular del AAA. Estudiamos a 334 pacientes incluidos en un ensayo clínico multicéntrico que evaluó la colocación de una prótesis endovascular en comparación con la corrección abierta estándar de un AAA infrarrenal. Se analizó la demografía, los historiales clínicos, los exámenes físicos, las variables de laboratorio, anatómicas, de la intervención, y del sistema estandarizado de puntuación del riesgo mediante un modelo multivariado de riesgos proporcionales de Cox. La tasa global de supervivencia fue del 89% a los 2 años. Las causas más comunes de fallecimiento fueron las cardiopatías, el cáncer y el ictus, y no se produjeron fallecimientos por rotura del AAA. El modelo de Cox demostró que existieron varios factores independientes predictivos del fallecimiento tras una corrección del AAA: índice de masa corporal bajo (p = 0,005), puntuación de riesgo pulmonar ≥ 1 según la Society for Vascular Surgery (p = 0,005), antecedentes de disfunción eréctil (p = 0,008), valvuloplastia cardíaca (p = 0,008), recuento preoperatorio de plaquetas bajo (p = 0,012), cociente diámetro AAA/diámetro del cuello proximal elevado (p = 0,020), y bajo índice tobillo-brazo (p = 0,031). En este estudio, la edad, el sexo, y el grupo de tratamiento abierto o endovascular no son factores de riesgo independiente significativos para la mortalidad a los 2 años. Los factores clínicos, de laboratorio y anatómicos predijeron la supervivencia tras la corrección abierta y endovascular de los AAA. Con la reducción progresiva de la mortalidad intrahospitalaria, la evaluación de la longevidad del paciente tras la corrección del AAA se ha convertido en un factor más importante en la toma de decisiones clínicas. El uso de factores válidos para predecir la supervivencia del paciente optimizará la utilización de los recursos y mejorará los resultados globales de los pacientes. Una mejor selección de los pacientes ante cualquier método de corrección permite mejorar la utilidad global más que la elección de una técnica de corrección abierta o endovascular.
    Anales de Cirugía Vascular 03/2009; 23(2). DOI:10.1016/j.acvsp.2008.07.036

Publication Stats

8k Citations
738.91 Total Impact Points


  • 1995–2014
    • Stanford University
      • • Department of Cardiothoracic Surgery
      • • Division of Interventional Radiology
      Palo Alto, California, United States
  • 2008–2013
    • University of Virginia
      • Department of Radiology and Medical Imaging
      Charlottesville, Virginia, United States
  • 1993–2012
    • Stanford Medicine
      • • Falk Cardiovascular Research Center
      • • Division of Interventional Radiology
      • • Program in Human Gene Therapy
      • • Department of Cardiothoracic Surgery
      • • Department of Radiology
      Stanford, California, United States
    • University of Michigan
      • Department of Radiology
      Ann Arbor, Michigan, United States
  • 2003
    • Sapienza University of Rome
      • Department of Radiological, Oncological and Pathological Sciences
      Roma, Latium, Italy
  • 2001
    • Savannah Vascular & Cardiac Institute
      Savannah, Georgia, United States