Evidence map›Paper›PMID 38608966›Full record

ArticleJournal of vascular surgery2024

Comparison of mortality and amputation after lower extremity bypass versus peripheral vascular intervention in patients with chronic limb-threatening ischemia and comorbid chronic kidney disease.

Jacob Cleman, Juan G Sierra, Gaëlle Romain, Bella Capuano, Lindsey Scierka, Santiago Callegari, Francky Jacque, Poghni Peri-Okonny, Sameer Nagpal, Kim G Smolderen and 1 more

Open access · bronzeAbstract readComparative Study
In one paragraph

Article in Journal of vascular surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
1.1field-weighted citation impact, top 24% 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

0 citing papers in PubMed, 2 citations in OpenAlex.

No citing paper in PubMed yet.

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

11 authors at 2 institutions in 1 country.

Jacob ClemanVascular Medicine Outcomes Program, Yale University, New Haven, CT.
Juan G SierraDepartment of Internal Medicine, Division of Cardiology, Naples Healthcare System, Naples Heart Institute, Naples, FL.
Gaëlle RomainVascular Medicine Outcomes Program, Yale University, New Haven, CT.
Bella CapuanoVascular Medicine Outcomes Program, Yale University, New Haven, CT.
Lindsey ScierkaVascular Medicine Outcomes Program, Yale University, New Haven, CT.
Santiago CallegariVascular Medicine Outcomes Program, Yale University, New Haven, CT.
Francky JacqueVascular Medicine Outcomes Program, Yale University, New Haven, CT.
Poghni Peri-OkonnyVascular Medicine Outcomes Program, Yale University, New Haven, CT.
Sameer NagpalVascular Medicine Outcomes Program, Yale University, New Haven, CT; Department of Internal Medicine, Division of Cardiology, Yale School of Medicine, New Haven, CT.
Kim G SmolderenVascular Medicine Outcomes Program, Yale University, New Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT.
Carlos Mena-HurtadoVascular Medicine Outcomes Program, Yale University, New Haven, CT; Department of Internal Medicine, Division of Cardiology, Yale School of Medicine, New Haven, CT. Electronic address: carlos.menahurtado@yale.edu.
Yale University · USNaples Community Hospital Healthcare System · US

Funding

Multi-isotope Hybrid PET/CT/ Imaging of Peripheral Artery Disease in Diabetes: Diversity Supplement Post Doctoral TrainingR01HL163640 · NHLBI · YALE UNIVERSITY · PI Chi Liu, Albert J Sinusas · 2023 to 2026
$3.4M
Training in Implementation Science Research and MethodsT32HL155000 · NHLBI · YALE UNIVERSITY · PI SPIEGELMAN, DONNA L, VELAZQUEZ, ERIC J · 2021 to 2025
$2.2M
Pain Management Strategies, Associated Psychological Variables, and Outcomes in Critical Limb IschemiaR21AT012430 · NCCIH · YALE UNIVERSITY · PI MENA-HURTADO, CARLOS, SMOLDEREN, KIM GERMAINE · 2022 to 2022
$461k
NCCIH NIH HHS R21 AT012430NHLBI NIH HHS R01 HL163640NHLBI NIH HHS T32 HL155000
6 · The paper itself

Abstract

objectiveComorbid chronic kidney disease (CKD) is associated with worse outcomes for patients with chronic limb-threatening ischemia (CLTI). However, comparative effectiveness data are limited for lower extremity bypass (LEB) vs peripheral vascular intervention (PVI) in patients with CLTI and CKD. We aimed to evaluate (1) 30-day all-cause mortality and amputation and (2) 5-year all-cause mortality and amputation for LEB vs PVI in patients with comorbid CKD.

methodsIndividuals who underwent LEB and PVI were queried from the Vascular Quality Initiative with Medicare claims-linked outcomes data. Propensity scores were calculated using 13 variables, and a 1:1 matching method was used. The mortality risk at 30 days and 5 years in LEB vs PVI by CKD was assessed using Kaplan-Meier and Cox proportional hazards models, with interaction terms added for CKD. For amputation, cumulative incidence functions and Fine-Gray models were used to account for the competing risk of death, with interaction terms for CKD added.

resultsOf 4084 patients (2042 per group), the mean age was 71.0 ± 10.8 years, and 69.0% were male. Irrespective of CKD status, 30-day mortality (hazard ratio [HR]: 0.94, 95% confidence interval [CI]: 0.63-1.42, P = .78) was similar for LEB vs PVI, but LEB was associated with a lower risk of 30-day amputation (sub-HR [sHR]: 0.66, 95% CI: 0.44-0.97, P = .04). CKD status, however, did not modify these results. Similarly, LEB vs PVI was associated with a lower risk of 5-year mortality (HR: 0.79, 95% CI: 0.71-0.88, P < .001) but no difference in 5-year amputation (sHR: 1.03, 95% CI: 0.89-1.20, P = .67). CKD status did not modify these results.

conclusionsRegardless of CKD status, patients had a lower risk of 5-year all-cause mortality and 30-day amputation with LEB vs PVI. Results may help inform preference-sensitive treatment decisions on LEB vs PVI for patients with CLTI and CKD, who may commonly be deemed too high risk for surgery.

Indexed as

Amputation, SurgicalChronic Limb-Threatening IschemiaComorbidityLimb SalvagePeripheral Arterial DiseaseRenal Insufficiency, ChronicAgedAged, 80 and overDatabases, FactualEndovascular ProceduresFemaleHumansIschemiaLower ExtremityMaleMedicareBypassChronic limb-threatening ischemiaComparative effectivenessEndovascularPeripheral artery disease

Identifiers

PMID38608966
PMCPMC11973903
OpenAlexW4394676010

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.