Evidence map›Paper›PMID 28739459›Full record

Observational studyAnnals of vascular surgery2018

Comparison of Direct and Less Invasive Techniques for the Treatment of Severe Aorto-Iliac Occlusive Disease.

Kimberly C Zamor, Andrew W Hoel, Irene B Helenowski, Adam W Beck, Joseph R Schneider, Karen J Ho

Open access · greenAbstract readComparative StudyMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Annals of vascular surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 2 pooled it
1.0field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 2 syntheses or guidelines pooled it, 10 citations in OpenAlex.

  1. Guideline
  2. Guideline
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Kimberly C ZamorDivision of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of General Surgery, Department of Surgery, Boston University School of Medicine, Boston, MA.
Andrew W HoelDivision of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Irene B HelenowskiDivision of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Adam W BeckDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida College of Medicine, Gainesville, FL.
Joseph R SchneiderDivision of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; Vascular Surgery and Interventional Radiology, Department of Surgery, Northwestern Medicine Regional Medical Group, Winfield, IL.
Karen J HoDivision of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: kho1@nm.org.
Northwestern University · USBoston University · USUniversity of Florida · US

Funding

Vascular Surgery Scientist Training ProgramT32HL094293 · NHLBI · NORTHWESTERN UNIVERSITY AT CHICAGO · PI ESKANDARI, MARK K · 2009 to 2023
$4.0M
NHLBI NIH HHS T32 HL094293
6 · The paper itself

Abstract

backgroundSevere aorto-iliac occlusive disease (AIOD) is traditionally treated with aorto-bifemoral bypass (ABF) or aorto-unifemoral bypass (AUF). However, cross-femoral bypass (CFB) and hybrid femoral endarterectomy and patch angioplasty with iliac stenting (EPS) have gained popularity as less invasive options. We sought to compare 1-year survival, primary patency, and major amputation rates between open surgical (ABF and AUF) and 2 less invasive reconstruction techniques (CFB and EPS) using a large, multicenter cohort. STUDY

designThis is a retrospective cohort study of patients who underwent either ABF/AUF or CFB/EPS for AIOD between 2006 and 2013 in the Society for Vascular Surgery Vascular Quality Initiative registry. Baseline patient and periprocedural variables were compared. Propensity score matching (PSM) was performed to predict the likelihood of more invasive repair. Kaplan-Meier analysis and Cox models were performed for 1-year survival, primary patency, and major amputation.

results1872 patients underwent procedures for AIOD, including 1,133 ABF/AUF and 739 CFB/EPS, during the study period. Indication was critical limb ischemia in 47.3% (n = 886). Median follow-up time was 305 days (range, 10-406). After PSM, the matched cohort included 1,094 ABF/AUF and 711 CFB/EPS patients. Multivariate analysis revealed that patient factors and procedure indication were significant predictors of 1-year mortality and major amputation, but not procedure type. ABF/AUF was associated with improved primary patency over CFB/EPS at 1 year (94.1% ± 1.1% vs. 92.3% ± 1.5%, hazard ratio 0.65, 95% confidence interval 0.45-0.94; P = 0.02).

conclusionsIn a propensity-matched cohort from a multicenter vascular surgery registry, a direct approach to AIOD (ABF/AUF) demonstrated better 1-year primary patency than commonly used less invasive strategies. However, treatment approach was not a predictor of 1-year survival or limb salvage, suggesting that patient factors and procedure indication have a greater impact on outcome.

Indexed as

AdolescentAdultAgedAged, 80 and overAmputation, SurgicalAortic DiseasesArterial Occlusive DiseasesFemaleHumansIliac ArteryKaplan-Meier EstimateLimb SalvageLogistic ModelsMaleMiddle AgedMultivariate Analysis

Identifiers

PMID28739459
PMCPMC5726928
OpenAlexW2736522474

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.